1174520407 NPI number — WILLOWBROOK HEALTH & HOME SERVICES, INC.

Table of content: (NPI 1174520407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174520407 NPI number — WILLOWBROOK HEALTH & HOME SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLOWBROOK HEALTH & HOME SERVICES, INC.
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:
1174520407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1451 ELM HILL PIKE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37210-5512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-366-6060
Provider Business Mailing Address Fax Number:
615-366-3331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1451 ELM HILL PIKE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37210-4560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-361-1951
Provider Business Practice Location Address Fax Number:
615-361-8173
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARGIS
Authorized Official First Name:
TINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR OF FINANCE & REIMBURSEMENT
Authorized Official Telephone Number:
615-366-3214

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  PSS0000000115 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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