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General NPI Number Information
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NPI Number | 1376094383
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Entity Type | Organization
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Legal Business Name | WILLOW BROOK CHRISTIAN SERVICES
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 100 WILLOW BROOK WAY S
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City | DELAWARE
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State | OH
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Zip | 43015-3249
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Country | US
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Telephone | 740-369-5447
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Fax | 740-369-7034
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Provider Business Mailing Address
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Address Line | 100 DELAWARE XING W
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City | DELAWARE
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State | OH
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Zip | 43015-7853
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Country | US
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Telephone | 740-201-5640
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Fax | 740-201-5670
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Authorized Official
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Title or Position | CFO
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Name | MR. THOMAS NEILL POULSON
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Credential |
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Telephone | 740-201-5671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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