Provider Demographics
NPI:1225789688
Name:WOODSIDE PLACE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:WOODSIDE PLACE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUWATOYIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:AKINYODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-551-9059
Mailing Address - Street 1:5867 LORENZO DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8765
Mailing Address - Country:US
Mailing Address - Phone:682-551-9059
Mailing Address - Fax:
Practice Address - Street 1:2705 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-1818
Practice Address - Country:US
Practice Address - Phone:682-551-9059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility