Provider Demographics
NPI:1033328901
Name:WOODLAND RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:WOODLAND RESIDENTIAL SERVICES, INC.
Other - Org Name:NORTH PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PARMINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAJLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-406-0333
Mailing Address - Street 1:1381 E GUM AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-4275
Mailing Address - Country:US
Mailing Address - Phone:530-406-0333
Mailing Address - Fax:
Practice Address - Street 1:418 NORTH ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3234
Practice Address - Country:US
Practice Address - Phone:530-406-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility