Healthcare Provider Details

I. General information

NPI: 1235368762
Provider Name (Legal Business Name): WOODLAND POND, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODLAND POND CIRCLE
NEW PALTZ NY
12561
US

IV. Provider business mailing address

100 WOODLAND POND CIRCLE
NEW PALTZ NY
12561
US

V. Phone/Fax

Practice location:
  • Phone: 845-256-5600
  • Fax: 845-256-5777
Mailing address:
  • Phone: 845-256-5600
  • Fax: 845-256-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5522303N
License Number StateNY

VIII. Authorized Official

Name: MICHELLE T GRAMOGLIA
Title or Position: CEO & PRESIDENT
Credential:
Phone: 845-256-5500