Provider Demographics
NPI:1265662530
Name:WOODY'S MOM, INC.
Entity Type:Organization
Organization Name:WOODY'S MOM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:HASKETT
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-757-6844
Mailing Address - Street 1:PO BOX 1631
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27512-1631
Mailing Address - Country:US
Mailing Address - Phone:919-757-6844
Mailing Address - Fax:919-651-1372
Practice Address - Street 1:1135 KILDAIRE FARM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7608
Practice Address - Country:US
Practice Address - Phone:919-757-6844
Practice Address - Fax:919-651-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management