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Organization

WCRL, LLC

Active
Other names
Willow Creek Retirement Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DAVID ROTOLO (MEMBER)
(601) 853-2667
Entity
Organization

Contact information

Practice address
49 WILLOW CREEK LN, JACKSON, MS 39272-9255
(601) 863-4201
(601) 863-4202
Mailing address
PO BOX 2712, RIDGELAND, MS 39158-2712
(601) 853-2667
(601) 853-2116

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
926
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00230143
MS
Enumeration date
11/20/2006
Last updated
02/20/2008
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