NPIMap

Organization Active NPI

Willow Glen Care Center

  • Mental Illness Community Based Residential Treatment Facility
  • Willits, CA
National Provider Identifier
1760819767
Registry record updated Jul 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
236803329 Issued in CA
Legal business name
WILLOW GLEN CARE CENTER
Practice address
414 S Main St
Willits, CA 95490-3908
Phone
(707) 459-6134
Fax
(707) 459-9252
NPI assigned
Oct 4, 2013
Organization subpart
Yes
Parent organization
WILLOW GLEN CARE CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 27, 2021

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

Authorized official

Name
Mr. Jeff Payne
Title
Chief Operations Officer
Phone
(530) 751-9904

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 236803329 CA Primary

Addresses

Primary practice location

414 S Main St
Willits, CA 95490-3908

Mailing address

1547 Plumas CT
Yuba City, CA 95991-2960
Phone (530) 751-9900

Other names 1

  • Redwood Creek Other name

National Provider Directory

National Provider Directory
Tax ID family
Willow Glen Care Center9 organizations share this tax ID, including this one
Part of
Willow Glen Care Center

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

414 S Main St
Willits, CA 95490
Phone (707) 459-6134

NPI Registry JSON

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

{
    "created_epoch": "1380844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627344000000",
    "number": "1760819767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1547 PLUMAS CT",
            "city": "YUBA CITY",
            "state": "CA",
            "postal_code": "959912960",
            "telephone_number": "530-751-9900",
            "fax_number": "530-751-9915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 S MAIN ST",
            "city": "WILLITS",
            "state": "CA",
            "postal_code": "954903908",
            "telephone_number": "707-459-6134",
            "fax_number": "707-459-9252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW GLEN CARE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLOW GLEN CARE CENTER",
        "enumeration_date": "2013-10-04",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "530-751-9904",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CA",
            "license": "236803329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Redwood Creek",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Willits, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; 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.