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General NPI Number Information
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NPI Number | 1992793962
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Entity Type | Organization
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Legal Business Name | WOODBURY WELLNESS CENTER INC
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 2778 COUNTRY CLUB DR
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City | HAMPSTEAD
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State | NC
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Zip | 28443-8028
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Country | US
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Telephone | 910-270-1443
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Fax | 910-270-1826
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Provider Business Mailing Address
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Address Line | 2778 COUNTRY CLUB DR
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City | HAMPSTEAD
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State | NC
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Zip | 28443-8028
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Country | US
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Telephone | 910-270-1443
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Fax | 910-270-1826
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Authorized Official
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Title or Position | BUSINESS OFFICE MGR
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Name | MRS. RENEE PRIDGEN
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Credential |
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Telephone | 910-270-1443
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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 | NH0300
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | NH0300
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH0300
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License Number State | NC
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