Ti-Willow Haven

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

HAL083012 Issued in NC

Legal business name

TI-WILLOW HAVEN

Practice address

1703 Stonewall Rd
Laurinburg, NC 28352-9706

Phone

(910) 276-9211

Fax

(910) 276-4535

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Joseph C Tutera

Title

Owner

Phone

(816) 444-0900

Specialties & licenses 1

Addresses

Other names 1

• Willow Place Doing business as

Locations

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1154409662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 STONEWALL RD",
            "city": "LAURINBURG",
            "state": "NC",
            "postal_code": "283529706",
            "telephone_number": "910-276-9211",
            "fax_number": "910-276-4535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 STONEWALL RD",
            "city": "LAURINBURG",
            "state": "NC",
            "postal_code": "283529706",
            "telephone_number": "910-276-9211",
            "fax_number": "910-276-4535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TI-WILLOW HAVEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "TUTERA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-444-0900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL083012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Care Home Facility in Laurinburg, NC
• Providers in Laurinburg, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.