Healthcare Provider Details

I. General information

NPI: 1831550110
Provider Name (Legal Business Name): WILLOW BEND HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5068 W PLANO PKWY STE 300
PLANO TX
75093-4409
US

IV. Provider business mailing address

5068 W PLANO PKWY STE 300
PLANO TX
75093-4409
US

V. Phone/Fax

Practice location:
  • Phone: 469-209-1819
  • Fax:
Mailing address:
  • Phone: 469-209-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateTX

VIII. Authorized Official

Name: JOY R POWELL
Title or Position: OWNER/DIRECTOR OF NURSING
Credential: BSN, RN
Phone: 469-209-1819