Willow Residence LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WILLOW RESIDENCE LLC

Practice address

3208 Park Ave
Minneapolis, MN 55407-2008

Phone

(612) 913-2975

NPI assigned

Jan 1, 2024

Organization subpart

No

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

Authorized official

Name

Faisa Yasin HusseinNPI 1003563883

Title

Owner

Phone

(612) 913-2975

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Faisa Hussein

  • Behavior Technician
  • Minneapolis, MN
  • NPI 1003563883
  NPD Authorized official

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

{
    "created_epoch": "1704067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1184493124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3208 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554072008",
            "telephone_number": "612-913-2975",
            "fax_number": "612-444-8984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3208 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554072008",
            "telephone_number": "612-913-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW RESIDENCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-01",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "HUSSEIN",
        "authorized_official_first_name": "FAISA",
        "authorized_official_middle_name": "YASIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-913-2975"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tisha Willis, FNP
• Lisa Willms, CD(DONA)
• Allison Willner, OTR/L
• Willow Midwives LTD
• Willow Midwives LTD
• Willow Wellbeing, LLC
• Carol Elaine Willow, LICSW
• Christie Ann Wills, APRN, NP-C
• Karen E Wills, PHD LP
• Laurel M Wills

• Assisted Living Facility in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.