Willow Creek

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

061808 Issued in NJ

Legal business name

WILLOW CREEK

Practice address

525 Fellowship Rd
Suite 360
Mount Laurel, NJ 08054-3415

Phone

(856) 813-2000

Fax

(856) 813-2020

NPI assigned

Mar 22, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Tramell C Clark

Title

Regional Resident Accounting MGR

Phone

(856) 813-2000

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194393600000",
    "number": "1962528695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 FELLOWSHIP RD",
            "address_2": "SUITE 360",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080543415",
            "telephone_number": "856-813-2000",
            "fax_number": "856-813-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 FELLOWSHIP RD",
            "address_2": "SUITE 360",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080543415",
            "telephone_number": "856-813-2000",
            "fax_number": "856-813-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2007-11-07",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TRAMELL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "REGIONAL RESIDENT ACCOUNTING MGR",
        "authorized_official_telephone_number": "856-813-2000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "061808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4498607",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4499301",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dana Lynn Willerton, PA-C
• William L. Shinefield
• Afton Williams
• Ashana Evette Williams, PH.D
• Kevin Matthew Williams, PHARMD.
• Willowglen Academy-New Jersey, Inc.
• Willowglen Academy-New Jersey, Inc.
• Wilscot Lamont
• Margaret O Wilson-Pearson, LCSW
• Cassandra Wilson, MA, BCBA, LBS, LBA

• Skilled Nursing Facility in Mount Laurel, NJ
• Providers in Mount Laurel, NJ by specialty
• Skilled Nursing Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; 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.