Provider Demographics
NPI:1154625085
Name:WILLOWS FIRSTCARE, INC
Entity type:Organization
Organization Name:WILLOWS FIRSTCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORPUS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:530-934-3385
Mailing Address - Street 1:460 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-2832
Mailing Address - Country:US
Mailing Address - Phone:530-934-3385
Mailing Address - Fax:530-934-3387
Practice Address - Street 1:460 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2832
Practice Address - Country:US
Practice Address - Phone:530-934-3385
Practice Address - Fax:530-934-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFH508AMedicare PIN