NPIMap

Organization Active NPI

Willowood Developmental Center

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Jackson, MS
National Provider Identifier
1831243070
Registry record updated Jan 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
WILLOWOOD DEVELOPMENTAL CENTER
Practice address
1635 Boling St
Jackson, MS 39213-4418
Phone
(601) 366-0123
NPI assigned
Jan 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2010

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

Authorized official

Name
Mr. Curtis E. Alford
Title
Executive Director
Phone
(601) 366-0123

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 235Z00000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X Primary

Addresses

Primary practice location

1635 Boling St
Jackson, MS 39213-4418

Mailing address

1635 Boling St
Jackson, MS 39213-4418
Phone (601) 366-0123

Other identifiers 2

IdentifierTypeStateIssuer
09015618MedicaidMS
00770062MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Willowood Developmental Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1635 Boling St
Jackson, MS 39213
Phone (601) 366-0123

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264550400000",
    "number": "1831243070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 BOLING ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134418",
            "telephone_number": "601-366-0123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 BOLING ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134418",
            "telephone_number": "601-366-0123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWOOD DEVELOPMENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2010-01-27",
        "status": "A",
        "authorized_official_last_name": "ALFORD",
        "authorized_official_first_name": "CURTIS",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-366-0123",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015618",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770062",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2010; 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.