OrganizationActive
Willow Place Living Center, LLC
NPI 1366524423 · Intellectual Disabilities Intermediate Care Facility · Wetumka, OK
Provider details
- NPI number
- 1366524423
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Donna Simmons, Office Manager(405) 380-6671
- License
- NH3203-3203 (OK)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
622 S Alabama St
Wetumka, OK 74883
Phone: (405) 452-3278
Fax: (405) 452-5154
Street-level locationGet directions
Mailing address
Po Box 488
Weleetka, OK 74880-0488
Other names (DBA / former)
- Doing business as
- Willow Place
Registry dates
- Enumerated
- 2006-10-19
- Last updated
- 2023-01-12
- Certified
- 2023-01-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.