Healthcare Provider Details

I. General information

NPI: 1255387601
Provider Name (Legal Business Name): WOOD LAKE HEALTH CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6414 13TH RD S
WEST PALM BEACH FL
33415-1401
US

IV. Provider business mailing address

6414 13TH RD S
WEST PALM BEACH FL
33415-1401
US

V. Phone/Fax

Practice location:
  • Phone: 561-478-9900
  • Fax: 561-478-5067
Mailing address:
  • Phone: 561-478-9900
  • Fax: 561-478-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF13390962
License Number StateFL

VIII. Authorized Official

Name: JOHN S. GLASS
Title or Position: MANAGER
Credential:
Phone: 561-478-9900