Healthcare Provider Details

I. General information

NPI: 1790029510
Provider Name (Legal Business Name): WOODLANDS HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6831 N CHESTNUT ST
RAVENNA OH
44266-3929
US

IV. Provider business mailing address

23700 COMMERCE PARK
BEACHWOOD OH
44122-5827
US

V. Phone/Fax

Practice location:
  • Phone: 330-297-4564
  • Fax: 330-298-4530
Mailing address:
  • Phone: 216-292-5706
  • Fax: 216-292-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2622N
License Number StateOH

VIII. Authorized Official

Name: WILLIAM I. WEISBERG
Title or Position: PRESIDENT
Credential:
Phone: 216-292-5706