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General NPI Number Information
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NPI Number | 1861071987
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Entity Type | Organization
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Legal Business Name | WOODS MANOR LLC
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 405 FRANKLIN RD
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City | GLASSBORO
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State | NJ
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Zip | 08028-1527
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Country | US
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Telephone | 856-244-0872
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Fax |
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Provider Business Mailing Address
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Address Line | 409 STEEPLECHASE CT
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City | DEPTFORD
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State | NJ
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Zip | 08096-6810
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Country | US
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Telephone | 856-244-8072
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TAMMY WOODS
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Credential |
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Telephone | 856-203-4195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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