Willow Manor Investors Inc

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

06-000004 Issued in IN

Legal business name

WILLOW MANOR INVESTORS INC

Practice address

1321 Willow St
Vincennes, IN 47591-4205

Phone

(812) 882-1136

Fax

(812) 882-7251

NPI assigned

Dec 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. Mark Ide

Title

Partner

Phone

(317) 670-1577

Specialties & licenses 1

Addresses

Other names 1

• Willow Manor Nursing Home Doing business as

Locations

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306914973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 WILLOW ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475914205",
            "telephone_number": "812-882-1136",
            "fax_number": "812-882-7251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 WILLOW ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475914205",
            "telephone_number": "812-882-1136",
            "fax_number": "812-882-7251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW MANOR INVESTORS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "IDE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "317-670-1577",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IN",
            "license": "06-000004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Manor Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paige Williams, MSW
• Tammy Lynn Williams, LCSW
• Wendy Lynette Williams, FNP-C
• William L Williams
• Dena Willis, PTA
• Stacy A Wilson, FNP
• Joshua James Winchell, MD
• Courtnee Winemiller, RBT
• Martin Christopher James Winkler
• Daelyn Wood, BSN RN

• All providers in Vincennes, IN
• Nursing Facility/Intermediate Care Facility in Indiana

• 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.