Provider Demographics
NPI:1124213657
Name:RICHARD WOODWARD
Entity Type:Organization
Organization Name:RICHARD WOODWARD
Other - Org Name:HILLVIEW HOME SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-542-5061
Mailing Address - Street 1:406 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2732
Mailing Address - Country:US
Mailing Address - Phone:423-543-4202
Mailing Address - Fax:423-543-6652
Practice Address - Street 1:1666 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-4116
Practice Address - Country:US
Practice Address - Phone:423-542-5061
Practice Address - Fax:423-542-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNI 438-126-9088251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445059Medicaid