MEDICARE: WOODLANDS AT EASTLAND LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1265767115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLANDS AT EASTLAND LLC

Provider Business Mailing Address
First Line	:	2469 KIMBERLY PKWY E
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4273
Country	:	US
Telephone Number	:	440-942-9933
Fax Number	:

Provider Business Practice Location Address
First Line	:	2469 KIMBERLY PKWY E
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4273
Country	:	US
Telephone Number	:	440-942-9933
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. STELLA MESODE NSONG
Credential	:	RN
Telephone Number	:	440-942-9933

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	10/13/2009

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