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General NPI Number Information
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NPI Number | 1235514522
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Entity Type | Organization
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Legal Business Name | COMFORT LIVING OF WOODLAND
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 615 W MAIN ST
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City | WOODLAND
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State | NC
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Zip | 27897-9618
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Country | US
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Telephone | 252-587-3333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 953
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City | AHOSKIE
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State | NC
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Zip | 27910-0953
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JANICE VAUGHAN
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Credential |
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Telephone | 252-642-4317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL-066-019
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License Number State | NC
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