Healthcare Provider Details

I. General information

NPI: 1427763853
Provider Name (Legal Business Name): WOODSIDE OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 LAKEWOOD BLVD
NAPLES FL
34112-6145
US

IV. Provider business mailing address

10150 HIGHLAND MANOR DR STE 300
TAMPA FL
33610-9712
US

V. Phone/Fax

Practice location:
  • Phone: 239-775-7757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: TRICIA THACKER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 813-558-6608