1891229241 NPI number — WOODLAND HOMES DAY PROGRAM,LLC.

Table of content: (NPI 1891229241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891229241 NPI number — WOODLAND HOMES DAY PROGRAM,LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODLAND HOMES DAY PROGRAM,LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891229241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1718
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARDWICK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31034-1718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-251-5643
Provider Business Mailing Address Fax Number:
478-932-5817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 N JEFFERSON ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLEDGEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31061-2532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-251-5643
Provider Business Practice Location Address Fax Number:
478-932-5817
Provider Enumeration Date:
04/12/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
MAXINE
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
478-251-5643

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  ADC000148 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com