Provider Demographics
NPI:1447421730
Name:CSH-ING WOODSIDE VILLAGE LP
Entity Type:Organization
Organization Name:CSH-ING WOODSIDE VILLAGE LP
Other - Org Name:WOODSIDE VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-287-3900
Mailing Address - Street 1:5426 BAY CENTER DR
Mailing Address - Street 2:SUITE #600
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3444
Mailing Address - Country:US
Mailing Address - Phone:813-287-3941
Mailing Address - Fax:
Practice Address - Street 1:19455 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2000
Practice Address - Country:US
Practice Address - Phone:440-439-8666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CSH-INGRE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6029310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility