Provider Demographics
NPI:1215935929
Name:WILLOWS OF SPRINGHURST OPCO, LLC
Entity type:Organization
Organization Name:WILLOWS OF SPRINGHURST OPCO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT & TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-412-5847
Mailing Address - Street 1:P.O. BOX 221648
Mailing Address - Street 2:ATTN LICENSURE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-1648
Mailing Address - Country:US
Mailing Address - Phone:502-412-5847
Mailing Address - Fax:502-213-9977
Practice Address - Street 1:3001 N HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2209
Practice Address - Country:US
Practice Address - Phone:502-426-5531
Practice Address - Fax:502-425-6988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY OPCP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100513314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12502134Medicaid
KY000000054655OtherANTHEM HEALTH PLANS
KY185305Medicare Oscar/Certification