Healthcare Provider Details

I. General information

NPI: 1982780680
Provider Name (Legal Business Name): WOODLAND COUNTRY MANOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4166 SOMERVILLE RD
SOMERVILLE OH
45064
US

IV. Provider business mailing address

4166 SOMERVILLE RD
SOMERVILLE OH
45064
US

V. Phone/Fax

Practice location:
  • Phone: 513-523-4449
  • Fax: 513-523-7900
Mailing address:
  • Phone: 513-523-4449
  • Fax: 513-523-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4548
License Number StateOH

VIII. Authorized Official

Name: MRS. LORI A AUER
Title or Position: ADMINISTRATOR
Credential:
Phone: 513-523-4449