Healthcare Provider Details

I. General information

NPI: 1063483337
Provider Name (Legal Business Name): WOODLAND ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 4TH STREET
WOODLAND WA
98674-8488
US

IV. Provider business mailing address

P.O. BOX 69
WOODLAND WA
98674-8488
US

V. Phone/Fax

Practice location:
  • Phone: 360-225-9443
  • Fax: 360-225-3703
Mailing address:
  • Phone: 360-225-9443
  • Fax: 360-225-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number749
License Number StateWA

VIII. Authorized Official

Name: MR. BRYAN M CLAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 360-794-9020