# WILLOW ROAD FACILITY

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

## Provider details

- **NPI number:** 1730366089
- **Authorized official:** MR. CORNELIUS WILLIAMS (OWNER)
- **Authorized official phone:** (252) 257-1814

## Contact information

- **Practice address:** 474 MACON EMBRO RD, MACON, NC 27551-9285
- **Practice address phone:** (252) 257-1814
- **Mailing address:** 474 MACON EMBRO RD, MACON, NC 27551-9285
- **Mailing address phone:** (252) 257-1814

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-093-034 | NC | Yes |

## Other

- **Enumeration date:** 01/29/2008
- **Last updated:** 01/29/2008