Provider Demographics
NPI:1366337859
Name:WILLOW'S GATE LLC
Entity type:Organization
Organization Name:WILLOW'S GATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANEK
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP
Authorized Official - Phone:402-672-1756
Mailing Address - Street 1:5511 S 146TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2644
Mailing Address - Country:US
Mailing Address - Phone:402-672-1756
Mailing Address - Fax:
Practice Address - Street 1:5511 S 146TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2644
Practice Address - Country:US
Practice Address - Phone:402-672-1756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service