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General NPI Number Information
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NPI Number | 1760126320
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Entity Type | Organization
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Legal Business Name | WILLOW BRIDGE LLC
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 2311 E DIVISION ST
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City | MOUNT VERNON
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State | WA
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Zip | 98274-4791
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Country | US
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Telephone | 425-678-3339
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 214
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City | MUKILTEO
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State | WA
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Zip | 98275-0214
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Country | US
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Telephone | 425-760-8551
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MOMODOU SOWE
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Credential |
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Telephone | 202-507-9826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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