Provider Demographics
NPI:1225680150
Name:WOODARD & ASSOCIATES
Entity Type:Organization
Organization Name:WOODARD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:909-815-2350
Mailing Address - Street 1:1214 S CYPRESS AVE
Mailing Address - Street 2:APT A
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-4915
Mailing Address - Country:US
Mailing Address - Phone:909-815-2350
Mailing Address - Fax:
Practice Address - Street 1:1214 S CYPRESS AVE
Practice Address - Street 2:APT A
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-4915
Practice Address - Country:US
Practice Address - Phone:909-815-2350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)