Provider Demographics
NPI:1265495436
Name:WILLEMOORE INC.
Entity type:Organization
Organization Name:WILLEMOORE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-275-4747
Mailing Address - Street 1:12400 S. HARLEM AVE SUITE 111
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1476
Mailing Address - Country:US
Mailing Address - Phone:708-424-7800
Mailing Address - Fax:708-424-9323
Practice Address - Street 1:12400 S. HARLEM AVE SUITE 111
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1476
Practice Address - Country:US
Practice Address - Phone:708-424-7800
Practice Address - Fax:708-424-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care