MEDICARE: WILLOW HEALTH CARE 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	314000000X	Skilled Nursing Facility	031482	MO
2	314000000X	Skilled Nursing Facility	036773	MO

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	:	1306847108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW HEALTH CARE INC

Provider Business Mailing Address
First Line	:	PO BOX 309
Second Line	:
City	:	WILLOW SPRINGS
State	:	MO
Zip	:	65793
Country	:	US
Telephone Number	:	417-469-3152
Fax Number	:	417-469-3443

Provider Business Practice Location Address
First Line	:	1410 N KENTUCKY AVE
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-1822
Country	:	US
Telephone Number	:	417-256-7975
Fax Number	:	417-469-3443

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MRS. SHERRY MILLER
Credential	:	CPA
Telephone Number	:	417-469-3152

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	12/18/2009

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Directions to “WILLOW HEALTH CARE INC ” Practice Location

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