Willow Creek Healthcare Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

040000418 Issued in CA

Legal business name

WILLOW CREEK HEALTHCARE CENTER, LLC

Doing business as

Willow Creek Healthcare Center

Practice address

650 W Alluvial Ave
Clovis, CA 93611-6716

Phone

(559) 323-6200

Fax

(559) 323-4665

NPI assigned

May 24, 2006

Organization subpart

Yes

Parent organization

SUMMIT CARE LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael T. Berg

Title

Assistant Secretary

Phone

(505) 468-4752

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Willow Creek Healthcare Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454284800000",
    "number": "1003861089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W ALLUVIAL AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936116716",
            "telephone_number": "559-323-6200",
            "fax_number": "559-323-4665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 W ALLUVIAL AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936116716",
            "telephone_number": "559-323-6200",
            "fax_number": "559-323-4665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK HEALTHCARE CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMIT CARE LLC",
        "enumeration_date": "2006-05-24",
        "last_updated": "2016-02-01",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "040000418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55652G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Creek Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Diondre Jermaine Williams
• Matthew Kevin Williams, PTA
• Samantha Williams
• Valerie R Williams
• Paula Jean Willis, PH.D.
• Willow Creek Post Acute, LLC (Willow Creek Healthcare Center)
• Aereyon Wilson
• Emily Rose Wilson, BCAT
• Jordyn L'Nae Wilson
• Myrick J Wilson Jr.

• Skilled Nursing Facility in Clovis, CA
• Providers in Clovis, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.