MEDICARE: WOODHOUSE, 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	4104096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922131796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODHOUSE, INC.

Provider Business Mailing Address
First Line	:	1001 NE 3RD AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-5712
Country	:	US
Telephone Number	:	954-786-0344
Fax Number	:	954-785-6635

Provider Business Practice Location Address
First Line	:	1001 NE 3RD AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-5712
Country	:	US
Telephone Number	:	954-786-0344
Fax Number	:	954-785-6635

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. MARSHA F. LINVILLE
Credential	:
Telephone Number	:	954-786-0344

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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Directions to “WOODHOUSE, INC. ” Practice Location

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