Provider Demographics
NPI:1093399230
Name:THE WOOD AGENCY HOME & LIFE
Entity Type:Organization
Organization Name:THE WOOD AGENCY HOME & LIFE
Other - Org Name:THE WOOD AGENCY HOME & LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-530-8298
Mailing Address - Street 1:3157 N RAINBOW BLVD # 192
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4578
Mailing Address - Country:US
Mailing Address - Phone:702-530-8298
Mailing Address - Fax:
Practice Address - Street 1:2350 S JONES BLVD STE 219
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3103
Practice Address - Country:US
Practice Address - Phone:702-530-8298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WOOD AGENCY HOME & LIFE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-12
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health