Provider Demographics
NPI:1174510010
Name:OAKWOOD VILLAGE UNIVERSITY WOODS HOMES, INC
Entity Type:Organization
Organization Name:OAKWOOD VILLAGE UNIVERSITY WOODS HOMES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STUDNICKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-230-4404
Mailing Address - Street 1:6201 MINERAL POINT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4503
Mailing Address - Country:US
Mailing Address - Phone:608-230-4456
Mailing Address - Fax:608-230-4489
Practice Address - Street 1:6201 MINERAL POINT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4503
Practice Address - Country:US
Practice Address - Phone:608-230-4318
Practice Address - Fax:608-230-4218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0081314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20128400Medicaid
WI33122500Medicaid
WI33122500Medicaid