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WILLOW PLACE
NPI 1366524423
Intermediate Care Facility, Intellectual Disabilities in Wetumka, OK

Active since October 19, 2006CLIA 37D0980489 · Waiver
622 S ALABAMA ST, WETUMKA, OK 74883(405) 452-3278(405) 452-5154 Get Directions Write a Review

NPPES record last updated: January 12, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 12, 2023, Aug 22, 2020 (2 updates tracked since 2020).

About Willow Place NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WILLOW PLACE (NPI 1366524423) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Wetumka, Oklahoma and active in the NPI registry since October 2006. The organization holds a CLIA Waiver certificate valid through November 21, 2026 and lists Donna R Simmons, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1366524423
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NameWILLOW PLACE LIVING CENTER, LLC
Location Address622 S ALABAMA STWetumka, OK 74883
Mailing AddressPo Box 488Weleetka, OK 74880-0488 · (405) 786-2266 · Fax (405) 786-2388
Phone(405) 452-3278
Fax(405) 452-5154
Organization SubpartNo
Authorized OfficialDonna R SimmonsOffice Manager · (405) 380-6671
Enumeration DateOctober 19, 2006
Last NPPES UpdateJanuary 12, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 12, 2023
✔ NPI 1366524423 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities
Taxonomy Code315P00000X
License✔ Licensed in OK · NH3203-3203
Definition
An intermediate care facility providing services for individuals with intellectual disabilities.
622 S ALABAMA ST, Wetumka, OK 74883
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Other Names 1

Doing Business AsWillow Place

Other Identifiers 1

Medicaid200106050AOK

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 37D0980489

Willow Place Living Center, LLC · Wetumka, OK
Active · expires Nov 21, 2026
CLIA Number37D0980489
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateNovember 22, 2024
Certificate Expiration DateNovember 21, 2026
Laboratory DirectorCrystal S. Freeman
Laboratory Phone(405) 452-3962
Laboratory LocationWillow Place Living Center, LLC622 S Alabama, Wetumka, OK 74883
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Willow Place Living Center, LLC's NPI number?

The NPI number for Willow Place Living Center, LLC is 1366524423. It was assigned to this organization in the NPPES registry on October 19, 2006. The provider is doing business as Willow Place.

Where is Willow Place Living Center, LLC located?

Willow Place Living Center, LLC is located at 622 S Alabama St, Wetumka, OK 74883. The listed phone number is (405) 452-3278.

What is Willow Place Living Center, LLC's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

Does Willow Place Living Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 37D0980489) is associated with this NPI, valid through November 21, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Willow Place Living Center, LLC was last updated on January 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.