Provider Demographics
NPI:1235368762
Name:WOODLAND POND, INC
Entity Type:Organization
Organization Name:WOODLAND POND, INC
Other - Org Name:KINGSTON REGIONAL SENIOR LIVING CORP.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:GRAMOGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-256-5500
Mailing Address - Street 1:100 WOODLAND POND CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561
Mailing Address - Country:US
Mailing Address - Phone:845-256-5600
Mailing Address - Fax:845-256-5777
Practice Address - Street 1:100 WOODLAND POND CIRCLE
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561
Practice Address - Country:US
Practice Address - Phone:845-256-5600
Practice Address - Fax:845-256-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
NY5522303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03280568Medicaid
335858Medicare UPIN
NY03280568Medicaid
NY5522303NMedicare Oscar/Certification