Provider Demographics
NPI:1275654923
Name:WILLOWS WAY, INC.
Entity type:Organization
Organization Name:WILLOWS WAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE AND OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-757-0506
Mailing Address - Street 1:800 FRIEDENS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4159
Mailing Address - Country:US
Mailing Address - Phone:636-947-6591
Mailing Address - Fax:636-947-7385
Practice Address - Street 1:800 FRIEDENS RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-4159
Practice Address - Country:US
Practice Address - Phone:636-947-6591
Practice Address - Fax:636-947-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO852962604Medicaid