Provider Demographics
NPI:1336140094
Name:WOODLAND CARE CENTER, LLC
Entity Type:Organization
Organization Name:WOODLAND CARE CENTER, LLC
Other - Org Name:WOODLAND PARK REHABILLITATION AND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, POLICY/GOVERNMENT RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-325-0153
Mailing Address - Street 1:255 E 400 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2846
Mailing Address - Country:US
Mailing Address - Phone:801-325-0153
Mailing Address - Fax:801-596-9001
Practice Address - Street 1:3855 S 700 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1157
Practice Address - Country:US
Practice Address - Phone:801-268-4766
Practice Address - Fax:801-268-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-NCF-59874314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT465094Medicare Oscar/Certification
UT=========001Medicaid