Healthcare Provider Details

I. General information

NPI: 1790855880
Provider Name (Legal Business Name): WOODWORTH COMMUNITY SERVICES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 S 15TH ST
PARSONS KS
67357-5125
US

IV. Provider business mailing address

1217 S 15TH ST
PARSONS KS
67357-5125
US

V. Phone/Fax

Practice location:
  • Phone: 620-421-0989
  • Fax: 620-423-3432
Mailing address:
  • Phone: 620-421-0989
  • Fax: 620-423-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA-050-006
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. DONALD R WOODWORTH
Title or Position: OWNER
Credential:
Phone: 620-421-0899