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General NPI Number Information
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NPI Number | 1710709936
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Entity Type | Organization
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Legal Business Name | THE WOODLANDS AT AMBER PARK LLC
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 401 HILL RD N
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City | PICKERINGTON
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State | OH
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Zip | 43147-1511
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Country | US
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Telephone | 614-834-3113
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Fax |
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Provider Business Mailing Address
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Address Line | 2418 FRYER PT
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City | FT LAUDERDALE
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State | FL
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Zip | 33305-2723
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Country | US
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Telephone | 239-272-2373
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CORNELIUS VAN DER VELDE JR.
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Credential |
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Telephone | 502-536-3468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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