Willowcreek Rehab and Nursing Center

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0041939 Issued in IL

Legal business name

WILLOWCREEK REHAB AND NURSING CENTER

Practice address

40 N 64TH St
Belleville, IL 62223-3808

Phone

(618) 397-8400

NPI assigned

Jul 6, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Stephen P Miller

Title

Member

Phone

(312) 994-2306

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201219200000",
    "number": "1356348221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 WESTGATE ST",
            "address_2": "SUITE 110",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011007",
            "telephone_number": "312-994-2306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 N 64TH ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622233808",
            "telephone_number": "618-397-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWCREEK REHAB AND NURSING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-06",
        "last_updated": "2008-01-25",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "312-994-2306",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "0041939",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0041939",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY LICENSE NUMBER",
            "identifier": "0041939",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Marie Williams, NP-C, FNP
• Tanaia Williams, LPN
• Tricia Lynn Williamson, RPH
• Jessica Marie Willis, FNP-C
• Juanita Willis
• Ella Nora Wilson, FNP
• Kevin Wilson, PA-C
• Thomas Wilson
• Reginald Patrick Wince II, LCSW
• Mary Ann E. Winkel, P.T.

• Skilled Nursing Facility in Belleville, IL
• Providers in Belleville, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2008; 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.