ETS WILLOWBROOK AT MARION (NPI# 1114420502) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114420502 |
| Entity Type | Organization |
| Organization Name | ETS WILLOWBROOK AT MARION |
| Other Organization Name | WILLOWBROOK |
| Practice Address |
1580 S Marion Ave Lake City FL 32025-6913 |
| Mailing Address |
7225 Drucilla St Pickerington OH 43147-7962 |
| Practice Telephone | 3867524454 |
| Mailing Telephone | 7409641240 |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2018-03-13 |
| Authorized Official Name | MR. JON SKYLAR BURGESS (SECRETARY/TREASURER) |
| Authorized Official Telephone | 6145655636 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 9909 | FL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Willowbrook | Doing Business As Name - Organization |
| Street Address |
1580 S MARION AVE |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32025-6913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801438353 | Jennifer Bennett | Pharmacist | 347 Sw Main Blvd Suite 102, Lake City, FL 32025 | 2019-10-16 |
| 1700352838 | Robert J Sansouci IIi IIi | Physical Therapy Assistant | 560 Sw Mcfarlane Ave, Lake City, Fl, 32025, Lake City, FL 32025 | 2018-10-16 |
| 1316442783 | Emily Bailey | Developmental Therapist | 2126 Sw Sisters Welcome Rd, Lake City, FL 32025 | 2018-03-28 |
| 1811446370 | Michelle Hart | Behavioral Analyst | 260 S. Marion Avenue, Bldg. A, Suite 135, Lake City, FL 32025 | 2016-09-26 |
| 1922467646 | Irene Aponte Moreno | Nurse Practitioner | 440 Sw Perimeter Glen, Lake City, FL 32025 | 2016-02-23 |
| 1093186777 | Decarlos Scippio | Counselor | 619 Sw Baya Drive Suite 102, Lake City, FL 32025 | 2015-10-07 |
| 1497132476 | Jamecia Legree | Registered Nurse | 800 Sw Symphony Loop, Bldg 15 Apt 204, Lake City, FL 32025 | 2015-04-29 |
| 1306249149 | Mercy Home Assisted Living Facility LLC | Assisted Living Facility | 184 S.e. Beech Street, Lake City, FL 32025 | 2014-10-08 |
| 1598174344 | Karen Mcdonald | Developmental Therapist | 4523 Se County Road 252, Lake City, FL 32025 | 2014-08-06 |
| 1275944126 | Mohammad Ali Faisal Mdpa | Specialist | 1283 Sw State Rd 47, Ste 104, Lake City, FL 32025 | 2014-05-14 |
| Find all providers in zip 32025 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235745753 | Shenay Fulton | Assisted Living Facility | 536 Nw Shelby Ter, Lake City, FL 32055-3280 | 2020-09-21 |
| 1265071153 | Serenity Hill Assisted Living Facility | Assisted Living Facility | 3534 230th Ter, Lake City, FL 32024-2714 | 2019-12-25 |
| 1902447527 | Harper Lake Operations, LLC | Assisted Living Facility | 213 Nw Gleason Dr, Lake City, FL 32055-5846 | 2019-10-04 |
| 1598247009 | Mardell Jackson | Assisted Living Facility | 197 Nw Gwen Lake Ave, Lake City, FL 32055-3711 | 2018-08-30 |
| 1306249149 | Mercy Home Assisted Living Facility LLC | Assisted Living Facility | 184 S.e. Beech Street, Lake City, FL 32025 | 2014-10-08 |
| 1467878454 | Hendrix, Smith, & Kirby LLC D/b/a Eastside Care Alf | Assisted Living Facility | 152 Se Defender Dr, Lake City, FL 32025-4990 | 2014-03-14 |
| 1881010072 | Summers Assisted Living Facility | Assisted Living Facility | 1225 Sw Grandview St, Lake City, FL 32025-0740 | 2014-03-12 |
| 1366866097 | Clara Ferguson I | Assisted Living Facility | 184 Se Beech St, Lake City, FL 32025-4982 | 2014-02-17 |
| 1417383241 | The Plantation On Summers LLC | Assisted Living Facility | 147 Sw Summers Ln, Lake City, FL 32025-0762 | 2013-09-25 |
| 1417392150 | Douglas Assisted Living Facility | Assisted Living Facility | 769 Ne Gurley Ave, Lake City, FL 32055-2453 | 2013-05-08 |
| Find all providers in LAKE CITY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.