Healthcare Provider Details

I. General information

NPI: 1982655627
Provider Name (Legal Business Name): ALTHEA WOODLAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DALEVIEW DR
SILVER SPRING MD
20901-3658
US

IV. Provider business mailing address

1000 DALEVIEW DR
SILVER SPRING MD
20901-3658
US

V. Phone/Fax

Practice location:
  • Phone: 301-434-2646
  • Fax: 301-439-9133
Mailing address:
  • Phone: 301-434-2646
  • Fax: 301-439-9133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number837
License Number StateMD

VIII. Authorized Official

Name: MR. RON CARSELL
Title or Position: PRESIDENT
Credential: LICENSED NHA
Phone: 301-434-2646