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Organization
WILLOW RESIDENTIAL LLC
Active
Organization
WILLOW RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANTII SAMSON (OWNER)
(704) 749-4564
Entity
Organization
Contact information
Practice address
2631 KENHILL DR, CHARLOTTE, NC 28208-5912
(704) 749-4564
Mailing address
2631 KENHILL DR, CHARLOTTE, NC 28208-5912
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/27/2026
Last updated
05/27/2026
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