Provider Demographics
NPI:1275911992
Name:WOODLANDS ASSISTED LIVING RESIDENCE-EASTLAND
Entity Type:Organization
Organization Name:WOODLANDS ASSISTED LIVING RESIDENCE-EASTLAND
Other - Org Name:WOODLANDS OF EASTLAND
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:216-219-0290
Mailing Address - Street 1:2469 KIMBERLY PKWY E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4273
Mailing Address - Country:US
Mailing Address - Phone:614-866-2080
Mailing Address - Fax:
Practice Address - Street 1:2469 KIMBERLY PKWY E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4273
Practice Address - Country:US
Practice Address - Phone:614-866-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RETIREMENT MANAGEMENT COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2072R305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization