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General NPI Number Information
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NPI Number | 1205982303
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Entity Type | Organization
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Legal Business Name | THE INN AT WILLOW FALLS
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1681 WILLOW CIRCLE DR
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City | CREST HILL
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State | IL
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Zip | 60435-2062
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Country | US
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Telephone | 815-725-5868
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Fax | 815-728-5853
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Provider Business Mailing Address
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Address Line | 1681 WILLOW CIRCLE DR
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City | CREST HILL
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State | IL
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Zip | 60435-2062
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Country | US
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Telephone |
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Fax | 815-728-5853
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SHARON S GOODE
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Credential | R.N.,C.,M.S.
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Telephone | 815-725-5868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 5100844
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License Number State | IL
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