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General NPI Number Information
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NPI Number | 1659377414
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Entity Type | Organization
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Legal Business Name | WOODLAND VILLAGE INC
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 425 MANOR DR
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City | SURING
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State | WI
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Zip | 54174-9182
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Country | US
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Telephone | 920-842-4132
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Fax | 920-842-4133
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Provider Business Mailing Address
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Address Line | 425 MANOR DR
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City | SURING
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State | WI
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Zip | 54174
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Country | US
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Telephone | 920-842-4132
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Fax | 920-842-4133
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JULIA HECKL
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Credential | RN
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Telephone | 920-842-4132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1017
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License Number State | WI
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