Willow Creek Assisted Living

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

License

100142 Issued in AK

Legal business name

WILLOW CREEK ASSISTED LIVING

Practice address

23281 W. Willow Fishhok Rd
Willow, AK 99688-0558

Phone

(907) 495-2999

Fax

(907) 495-9199

NPI assigned

Nov 24, 2008

Last updated

Nov 24, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Roberta Ellen Sandoval

Title

Administrator

Phone

(907) 495-2999

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1227484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227484800000",
    "number": "1710132345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23281 W. WILLOW FISHOOK RD",
            "address_2": "PO BOX 558",
            "city": "WILLOW",
            "state": "AK",
            "postal_code": "996880558",
            "telephone_number": "907-495-2999",
            "fax_number": "907-495-9199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23281 W. WILLOW FISHHOK RD",
            "city": "WILLOW",
            "state": "AK",
            "postal_code": "996880558",
            "telephone_number": "907-495-2999",
            "fax_number": "907-495-9199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-24",
        "last_updated": "2008-11-24",
        "status": "A",
        "authorized_official_last_name": "SANDOVAL",
        "authorized_official_first_name": "ROBERTA",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "907-495-2999",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "AK",
            "license": "100142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sunshine Community Health Center Inc
• Sunshine Community Health Center, Inc (Sunshine Communith Health Willow Dental Clinic)
• Sunshine Community Health Center, Inc. (Sunshine Community Health Center Pharmacy - Willow)
• Telebehavioral Medicine Associates Inc.
• Upper Su Valley Care Coordination
• Willow Personal Care Assistants, LLC
• Virginia N Wodkowski

• Developmental Disabilities Clinic/Center in Willow, AK
• Providers in Willow, AK by specialty
• Developmental Disabilities Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 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.