Provider Demographics
NPI:1033943428
Name:WILLOWBROOK HEALTHCARE GROUP, LLC
Entity type:Organization
Organization Name:WILLOWBROOK HEALTHCARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-605-9939
Mailing Address - Street 1:2323 CONCRETE RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:KY
Mailing Address - Zip Code:40311-9707
Mailing Address - Country:US
Mailing Address - Phone:731-588-4302
Mailing Address - Fax:731-588-4303
Practice Address - Street 1:2323 CONCRETE RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:KY
Practice Address - Zip Code:40311-9707
Practice Address - Country:US
Practice Address - Phone:731-588-4302
Practice Address - Fax:731-588-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility