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General NPI Number Information
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NPI Number | 1780141846
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Entity Type | Organization
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Legal Business Name | WILLOWBROOK WEST LLC
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 507 NW HALL OF FAME DR
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City | LAKE CITY
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State | FL
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Zip | 32055-4835
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Country | US
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Telephone | 386-755-6560
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 NEIL AVE
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City | COLUMBUS
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State | OH
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Zip | 43201-3121
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EAMON BURGESS
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Credential |
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Telephone | 614-440-4393
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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 |
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License Number State |
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