Healthcare Provider Details

I. General information

NPI: 1629060702
Provider Name (Legal Business Name): WOODLAND NURSING INN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 MT DIABLO BLVD
LAFAYETTE CA
94549-3538
US

IV. Provider business mailing address

3 CROW CANYON CT
SAN RAMON CA
94583-1966
US

V. Phone/Fax

Practice location:
  • Phone: 925-284-5544
  • Fax: 925-284-5673
Mailing address:
  • Phone: 925-855-0881
  • Fax: 925-855-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateCA

VIII. Authorized Official

Name: JEREMY E GRIMES
Title or Position: PRESIDENT
Credential:
Phone: 925-855-0881