Organization
THE WILLOW FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN BRITTON (EXECUTIVE DIRECTOR)
(575) 578-0069
Entity
Organization
Contact information
Practice address
1405 MADISON AVE, ROSWELL, NM 88203-5535
(575) 578-0069
Mailing address
1405 MADISON AVE, ROSWELL, NM 88203-5535
(575) 578-0069
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/04/2010
Last updated
05/04/2010
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