WILLOW RESIDENTIAL LLC – NPI #1154252203
Residential Treatment Facility, Emotionally Disturbed Children

A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.

Health Care Provider Taxonomy Code for Residential Treatment Facility, Emotionally Disturbed Children

WILLOW RESIDENTIAL LLC is a residential treatment facility located in CHARLOTTE, NC. NPPES recently assigned the NPI number 1154252203 to WILLOW RESIDENTIAL LLC on May 27, 2026. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 322D00000X from the Health Care Provider Taxonomy code set, which is classified as Residential Treatment Facility, Emotionally Disturbed Children.

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for WILLOW RESIDENTIAL LLC below.

NPI Profile for
WILLOW RESIDENTIAL LLC

NPI Number
1154252203
Enumeration Date

(about a week ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
WILLOW RESIDENTIAL LLC
Primary location
2631 KENHILL DR
CHARLOTTE, NC 28208-5912
Phone: (704) 749-4564 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
AMANTII SAMSON
OWNER
Phone: (704) 749-4564
Updated
Certification Date
May 27, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
322D00000X
- Residential Treatment Facility, Emotionally Disturbed Children (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.