Provider Demographics
NPI:1306847108
Name:WILLOW HEALTH CARE INC
Entity type:Organization
Organization Name:WILLOW HEALTH CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:417-469-3152
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793
Mailing Address - Country:US
Mailing Address - Phone:417-469-3152
Mailing Address - Fax:417-469-3443
Practice Address - Street 1:1410 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1822
Practice Address - Country:US
Practice Address - Phone:417-256-7975
Practice Address - Fax:417-469-3443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLOW HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-03
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031482314000000X
MO036773314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101763100Medicaid
MO101763100Medicaid