MEDICARE: WOODLAND RESIDENTIAL SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility		CA

General Provider Information

NPI Number	:	1033328901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAND RESIDENTIAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	1381 E GUM AVE
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95776-4275
Country	:	US
Telephone Number	:	530-406-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	418 NORTH ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-3234
Country	:	US
Telephone Number	:	530-406-0333
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PARMINDER KAJLEY
Credential	:
Telephone Number	:	530-406-0333

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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