MEDICARE: WILLOW CREST, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL-1024	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124186093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW CREST, INC.

Provider Business Mailing Address
First Line	:	1410 E BUENA VENTURA ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2825
Country	:	US
Telephone Number	:	719-473-6339
Fax Number	:	719-448-9301

Provider Business Practice Location Address
First Line	:	1209 E. CARAMILLO ST.
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909
Country	:	US
Telephone Number	:	719-473-6339
Fax Number	:	719-448-9301

Authorized Official
Title or Position	:	PESIDENT
Name	:	MR. KARL D. SCHMIDT
Credential	:
Telephone Number	:	719-473-6339

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	08/22/2020

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Directions to “WILLOW CREST, INC. ” Practice Location

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