NPIMap

Organization Active NPI

Willow Health Care Inc

Doing business as Copper Rock Healthcare

  • Skilled Nursing Facility
  • Rogersville, MO
National Provider Identifier
1184276982
Registry record updated Jul 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WILLOW HEALTH CARE INC
Doing business as
Copper Rock Healthcare
Practice address
712 Copper Rock Dr
Rogersville, MO 65742-8970
Phone
(417) 469-0204
Fax
(417) 469-3443
NPI assigned
Jul 11, 2019
Last updated
Jul 11, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
WILLOW HEALTH CARE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 11, 2019

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

Authorized official

Name
Jackie Williamson
Title
Medicare Insurance Coordinator
Phone
(417) 469-0204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

712 Copper Rock Dr
Rogersville, MO 65742-8970

Mailing address

PO Box 309
Willow Springs, MO 65793-0309
Phone (417) 469-0204

Other names 1

  • Copper Rock Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190826002893 MO Part A Provider - Skilled Nursing Facility 2062401466 Practice locations: Rogersville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184276982. Details of each certification follow.

Skilled nursing facility certification: CCN 265878

Legal name
WILLOW HEALTH CARE INC
Doing business as
COPPER ROCK HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 3, 2019
Last certification
Jan 25, 2024
Beds
90
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Willow Health Care Inc.
Organization structure
OtherNon-profit
Incorporated
Jan 16, 1978 in MO
Enrollment address
712 Copper Rock Dr
Rogersville, MO 65742-8970
Nursing home name
COPPER ROCK HEALTHCARE

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Copper Rock HealthcareCCN 265878 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Oct 3, 2019
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9074.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2168566Copper Rock Healthcare712 Copper Rock Drive, Rogersville, MO 65742Certificate of waiverJul 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Westwood Home Care11 organizations share this tax ID, including this one
Part of
Westwood Home Care

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

712 Copper Rock Dr
Rogersville, MO 65742
Phone (417) 202-4606

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mary Gregory Individual Corporate OfficerVP of Human Resources May 24, 2004
Shirley Alter Individual Corporate OfficerInterim Ceo Jul 1, 2019
Roy G Pace Individual Corporate OfficerVP of Operations Jul 20, 2018
W-2 Managing Employee Sep 1, 2020
Sherry Miller Individual Corporate OfficerCfo, Vice President of Finance Oct 16, 1994

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Brooke Haven HealthcareWest Plains, MO, CCN 265400 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 1, 2003
Nov 1, 2003
Mountain View HealthcareMountain View, MO, CCN 265412 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 22, 2009
Willow Care Nursing HomeWillow Springs, MO, CCN 265335 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 2, 2009
Ozark Riverview ManorOzark, MO, CCN 265464 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2015
Oct 1, 2015
Westwood Home HealthWillow Springs, MO, CCN 267505 Home health agency 5% Or Greater Direct Ownership Interest (100%) Dec 2, 2009
Westwood Rural Health ClinicWillow Springs, MO, CCN 793860 Rural health clinic 5% Or Greater Direct Ownership Interest Dec 2, 2009

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562803200000",
    "number": "1184276982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 309",
            "city": "WILLOW SPRINGS",
            "state": "MO",
            "postal_code": "657930309",
            "telephone_number": "417-469-0204",
            "fax_number": "417-469-3443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 COPPER ROCK DR",
            "city": "ROGERSVILLE",
            "state": "MO",
            "postal_code": "657428970",
            "telephone_number": "417-469-0204",
            "fax_number": "417-469-3443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW HEALTH CARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLOW HEALTH CARE INC",
        "enumeration_date": "2019-07-11",
        "last_updated": "2019-07-11",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "MEDICARE INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "417-469-0204"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Copper Rock Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rogersville, MO

Sources for this page

Verify at the official NPI Registry.