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General NPI Number Information
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NPI Number | 1154313278
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Entity Type | Organization
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Legal Business Name | WOODLAWN LP
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 2219 WOODLAWN
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City | GUTHRIE
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State | OK
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Zip | 73044
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Country | US
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Telephone | 405-282-3630
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Fax | 405-282-7847
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Provider Business Mailing Address
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Address Line | PO BOX 977
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City | GUTHRIE
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State | OK
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Zip | 73044
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Country | US
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Telephone | 405-282-2600
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Fax | 405-282-2610
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Authorized Official
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Title or Position | MANAGER
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Name | MR. GREG MACHTOLFF
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Credential |
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Telephone | 405-282-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | NH4205
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License Number State | OK
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