MEDICARE: WOODLAWN L L C

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	NH6201	OK

General Provider Information

NPI Number	:	1356343792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAWN L L C

Provider Business Mailing Address
First Line	:	PO BOX 1185
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74821-1185
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 N COUNTRY CLUB RD
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2845
Country	:	US
Telephone Number	:	580-332-3631
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DEBRA JONES
Credential	:
Telephone Number	:	580-332-3631

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	08/22/2020

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Directions to “WOODLAWN L L C ” Practice Location

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