Willow Residential LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

WILLOW RESIDENTIAL LLC

Practice address

2631 Kenhill Dr
Charlotte, NC 28208-5912

Phone

(704) 749-4564

NPI assigned

May 27, 2026

Last updated

May 27, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amantii Samson

Title

Owner

Phone

(704) 749-4564

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1779840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779840000000",
    "number": "1154252203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2631 KENHILL DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2631 KENHILL DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085912",
            "telephone_number": "704-749-4564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW RESIDENTIAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-05-27",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A",
        "authorized_official_last_name": "SAMSON",
        "authorized_official_first_name": "AMANTII",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-749-4564"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2026; 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.