1285962464 NPI number — WILLOW PERSONAL CARE ASSISTANTS, LLC

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 1285962464 NPI number — WILLOW PERSONAL CARE ASSISTANTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLOW PERSONAL CARE ASSISTANTS, 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:
1285962464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 624
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLOW
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99688-0624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-495-6778
Provider Business Mailing Address Fax Number:
907-495-6779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MILE 69. 1 PARKS HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLOW
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-495-6778
Provider Business Practice Location Address Fax Number:
907-495-6779
Provider Enumeration Date:
11/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DAHLEN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
907-495-6778

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; 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