Healthcare Provider Details

I. General information

NPI: 1063493872
Provider Name (Legal Business Name): WOODLAND PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 GREENVILLE RD
MERCER PA
16137-5023
US

IV. Provider business mailing address

745 GREENVILLE RD
MERCER PA
16137-5023
US

V. Phone/Fax

Practice location:
  • Phone: 724-662-5400
  • Fax: 724-662-2043
Mailing address:
  • Phone: 724-662-5400
  • Fax: 724-662-2043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number132402
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001279
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK MANAGED CARE
# 2
IdentifierV0044A
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC MANAGED CARE
# 3
Identifier0016782520001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. DREW C PIERCE
Title or Position: CHIEF OPERATING OFFICER
Credential: CPA
Phone: 724-662-5400