1376094383 NPI number — WILLOW BROOK CHRISTIAN SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376094383 NPI number — WILLOW BROOK CHRISTIAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLOW BROOK CHRISTIAN SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376094383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 DELAWARE XING W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELAWARE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43015-7853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-201-5640
Provider Business Mailing Address Fax Number:
740-201-5670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 WILLOW BROOK WAY S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELAWARE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43015-3249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-369-5447
Provider Business Practice Location Address Fax Number:
740-369-7034
Provider Enumeration Date:
10/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
POULSON
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
NEILL
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
740-201-5671

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com