# WILLOW RESIDENTIAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154252203
- **Authorized official:** AMANTII SAMSON (OWNER)
- **Authorized official phone:** (704) 749-4564

## Contact information

- **Practice address:** 2631 KENHILL DR, CHARLOTTE, NC 28208-5912
- **Practice address phone:** (704) 749-4564
- **Mailing address:** 2631 KENHILL DR, CHARLOTTE, NC 28208-5912

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 05/27/2026
- **Last updated:** 05/27/2026