Organization
WILLOW TREE WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY BROOKE UPCHURCH (OWNER)
(217) 962-0614
Entity
Organization
Contact information
Practice address
2046 JONATHAN CREEK RD, ARTHUR, IL 61911-6108
(217) 962-0614
Mailing address
2046 JONATHAN CREEK RD, ARTHUR, IL 61911-6108
(217) 962-0614
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306215157
NPI
—
Enumeration date
01/08/2024
Last updated
01/08/2024
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