Provider Demographics
NPI:1487657581
Name:WOODWORTH ENTERPRISES, INC.
Entity Type:Organization
Organization Name:WOODWORTH ENTERPRISES, INC.
Other - Org Name:ELMHAVEN EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-421-2431
Mailing Address - Street 1:1217 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-5125
Mailing Address - Country:US
Mailing Address - Phone:620-421-1430
Mailing Address - Fax:620-421-1437
Practice Address - Street 1:1400 S 15TH ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-5130
Practice Address - Country:US
Practice Address - Phone:620-421-1430
Practice Address - Fax:620-421-1437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODWORTH ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-23
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN050008314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0005136OtherTRADING PARTNER
KS100109540AMedicaid
KS100109540AMedicaid