1518390145 NPI number — WILLOW HOSPICE AND PALLIATIVE CARE, LLC

Table of content: MS. SHRUTI JOSHI PT, MS (NPI 1740484765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518390145 NPI number — WILLOW HOSPICE AND PALLIATIVE CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLOW HOSPICE AND PALLIATIVE CARE, LLC
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:
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:
1518390145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13246 S ROUTE 59 STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60585-9801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-230-3910
Provider Business Mailing Address Fax Number:
815-230-3930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13246 S ROUTE 59 STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60585-9801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-230-3910
Provider Business Practice Location Address Fax Number:
815-230-3930
Provider Enumeration Date:
08/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MANABAT
Authorized Official First Name:
HERMINIA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
815-508-5253

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  2003105 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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