Willow Park Convalescent Home,Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

4104 Issued in OH

Legal business name

WILLOW PARK CONVALESCENT HOME,INC.

Practice address

18810 Harvard Ave
Cleveland, OH 44122-6848

Phone

(216) 752-3600

Fax

(216) 752-5612

NPI assigned

Jun 9, 2005

Organization subpart

No

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

Authorized official

Name

Adam J White, MBA

Title

Ar Manager

Phone

(614) 416-2638

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194729038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18810 HARVARD AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441226848",
            "telephone_number": "216-752-3600",
            "fax_number": "216-752-5612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18810 HARVARD AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441226848",
            "telephone_number": "216-752-3600",
            "fax_number": "216-752-5612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW PARK CONVALESCENT HOME,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "AR MANAGER",
        "authorized_official_telephone_number": "614-416-2638",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "4104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2402519",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Riccardo Willis
• Lisa Anne Willman, LPCC-S
• Deborah J Willner, P.A.
• Kathryn Adele Willner, CNP
• Willow Glen
• Cheryl Wills, MD
• Courtney Lynn Wills
• Danielle Wills
• Eddie Wills Jr., M.D.
• Mary Wills, LSW

• Skilled Nursing Facility in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.