Organization
WILLOW CREEK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRAMELL C CLARK (REGIONAL RESIDENT ACCOUNTING MGR)
(856) 813-2000
Entity
Organization
Contact information
Practice address
525 FELLOWSHIP RD, SUITE 360, MOUNT LAUREL, NJ 08054-3415
(856) 813-2000
(856) 813-2020
Mailing address
525 FELLOWSHIP RD, SUITE 360, MOUNT LAUREL, NJ 08054-3415
(856) 813-2000
(856) 813-2020
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
061808
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4498607
—
NJ
05
—
4499301
—
NJ
Enumeration date
03/22/2007
Last updated
11/07/2007
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