MEDICARE: WOODLAND PLACE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	132402	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001279	OTHER	PA	HIGHMARK MANAGED CARE
2	V0044A	OTHER	PA	UPMC MANAGED CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063493872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAND PLACE

Provider Business Mailing Address
First Line	:	745 GREENVILLE RD
Second Line	:
City	:	MERCER
State	:	PA
Zip	:	16137-5023
Country	:	US
Telephone Number	:	724-662-5400
Fax Number	:	724-662-2043

Provider Business Practice Location Address
First Line	:	745 GREENVILLE RD
Second Line	:
City	:	MERCER
State	:	PA
Zip	:	16137-5023
Country	:	US
Telephone Number	:	724-662-5400
Fax Number	:	724-662-2043

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. DREW C PIERCE
Credential	:	CPA
Telephone Number	:	724-662-5400

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	01/04/2010

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Directions to “WOODLAND PLACE ” Practice Location

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