Healthcare Provider Details

I. General information

NPI: 1528934163
Provider Name (Legal Business Name): WOODRUFF CORPORATION LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 GREENOB DR
ENGLEWOOD OH
45322-2208
US

IV. Provider business mailing address

1011 GREENOB DR
ENGLEWOOD OH
45322-2208
US

V. Phone/Fax

Practice location:
  • Phone: 937-414-9516
  • Fax: 937-414-9516
Mailing address:
  • Phone: 937-414-9516
  • Fax: 937-414-9516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. NICOLE L WOODRUFF
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 937-414-9516