Provider Profile
WILLOW CREEK
Assisted Living Facility
FACILITY PROFILE
Street Address
- 507 NW HALL OF FAME DR
LAKE CITY, FL 32055-4835
County: Columbia - Phone: (386) 755-6560
Mailing Address
- 507 NW HALL OF FAME DR
LAKE CITY, FL 32055-4835
County: Columbia - Phone: (386) 755-6560
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Facility Information:
| Facility/Provider Type: | Assisted Living Facility | |||||||||
| Administrator: | JOHNATHAN COGHLAN | |||||||||
| Financial Officer: | EAMON L BURGESS | |||||||||
| Owner/Licensee: | WILLOWBROOK WEST LLC | |||||||||
| Owner/Licensee Since: | 2/28/2019 | |||||||||
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| Profit Status: | For-Profit | |||||||||
| Management Company: | Not Available | |||||||||
| Manager Since: | Not Available | |||||||||
| Licensed Beds: | 72 | |||||||||
| Bed Types: | Private: 72 Optional State Supplement: 0 Total Capacity: 72 Extended Congregate Care: 0 | |||||||||
| AHCA Number (File Number): | 11965001 | |||||||||
| AHCA Field Office: | 03 | |||||||||
| License Number: | 9472 | |||||||||
| Current License Effective: | 12/4/2024 | |||||||||
| Current License Expires: | 5/28/2025 | |||||||||
| License Status: | CLOSED | |||||||||
Services/Characteristics
| Medicaid Services: | Assistive Care Services |
| Activities: | Arts and CraftsDancingExercise ClassesGames/CardsGardeningMusic ProgramsOtherShoppingSocial Events/OutingsTheater and Movies |
| Bed Hold Policy: | Facility will hold beds during a temporary absence |
| Adult Day Care Services: | Yes |
| Continuing Care Retirement Community: | No |
| Languages Spoken: | English |
| Nurse Availability: | Direct Part-Time |
| Payment Forms Accepted: | Insurance and/or HMOMedicaidVA |
| Special Programs and Services: | Memory CarePhysical Therapy |
Emergency Power Plan Summary
| Onsite Alternate Power Source: | Fixed Generator |
| Emergency Power Supports: | Entire FacilityOther |
| Plan Approval: | 6/11/2019 |
| Implementation Date: | 6/1/2018 |
| Cooling Method: | Air ConditionerOther |
| Areas Cooled: | Entire FacilityHallwayResident Rooms |
| Square Footage Cooled: | 21711 |
| Number of People to use Cooled Space: | 79 |
Legal Actions
| Date Initiated | Case # | Case Type | Violation | Fine Amount | Date Imposed |
|---|---|---|---|---|---|
| Change of ownership occurred 2/28/2019 | |||||
| 7/13/2015 | 2015007592 | Fine | Survey | $1,000.00 | 9/18/2017 |
| 7/12/2012 | 2012007530 | Fine | Survey | $3,000.00 | 6/24/2013 |
| 5/5/2005 | 2005004166 | Fine | Survey | $2,000.00 | 3/9/2006 |
Important information and facility/provider definitions can be found in the Glossary.
Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.