WILLOW CREEK BEHAVIORAL HEALTH
Complete NPI Record 1861993172
Psychiatry & Neurology - Psychiatry in Green Bay, WI
NPI Status: Active since February 22, 2018
Complete NPI Dataset
The following table represents the complete dataset for NPI number 1861993172. The table includes a list of all field names, values and definitions of the full NPI record. This dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.
| Name | Value | Definition |
|---|---|---|
| NPI | 1861993172 | The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Entity Type Code | 2 | Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Employer Identification Number EIN | UNAVAIL | The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
| Provider Organization Name Legal Business Name | SBH-GREEN BAY LLC | The name of the organization provider. If the provider is an organization, this is the legal business name. |
| Provider Other Organization Name | WILLOW CREEK BEHAVIORAL HEALTH | Other name by which the organization provider is or has been known. |
| Provider Other Organization Name Type Code | 3 | Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
| Provider First Line Business Mailing Address | 8295 TOURNAMENT DR STE 201 | The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’. |
| Provider Business Mailing Address City Name | MEMPHIS | The city name in the mailing address of the provider being identified. |
| Provider Business Mailing Address State Name | TN | The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’. |
| Provider Business Mailing Address Postal Code | 381258913 | The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’. |
| Provider Business Mailing Address Country Code If outside U S | US | The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’. |
| Provider First Line Business Practice Location Address | 1351 ONTARIO RD | The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Provider Business Practice Location Address City Name | GREEN BAY | The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name | WI | The State code in the location of the provider being identified. |
| Provider Business Practice Location Address Postal Code | 543118302 | The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address Country Code If outside U S | US | The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number | 9203281220 | The telephone number associated with the location address of the provider being identified. |
| Provider Enumeration Date | 2/22/2018 | The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date | 9/29/2023 | The date that a record was last updated or changed. |
| Authorized Official Last Name | GILBERT | The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Authorized Official First Name | PAUL | The first name of the authorized official. |
| Authorized Official Title or Position | CHIEF LEGAL OFFICER | The title or position of the authorized official. |
| Authorized Official Telephone Number | 6157164924 | The 10-position telephone number of the authorized official. |
| Healthcare Provider Taxonomy Code 1 | 2084P0800X | Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Healthcare Provider Primary Taxonomy Switch 1 | Y | |
| Is Organization Subpart | N | |
| Healthcare Provider Taxonomy Group 1 | 193400000X SINGLE SPECIALTY GROUP | |
| NPI Certification Date | 9/29/2023 |