Healthcare Provider Details

I. General information

NPI: 1558668905
Provider Name (Legal Business Name): WILLOW WINDS LIVING, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 09/26/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N372/374 TWINKLING STAR RD N346/378 TWINKLING STAR RD
WHITEWATER WI
53190
US

IV. Provider business mailing address

W7704 R AND W TOWNLINE RD
WHITEWATER WI
53190
US

V. Phone/Fax

Practice location:
  • Phone: 920-723-1429
  • Fax:
Mailing address:
  • Phone: 920-723-1429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number0013560
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0013560
License Number StateWI

VIII. Authorized Official

Name: LEONARD LESLIE KLINE
Title or Position: OWNER
Credential:
Phone: 920-723-1429