Provider Demographics
NPI:1518583970
Name:WOODLAND HEIGHTS LLC
Entity Type:Organization
Organization Name:WOODLAND HEIGHTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-358-1567
Mailing Address - Street 1:9355 SW MCDONALD ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-5906
Mailing Address - Country:US
Mailing Address - Phone:503-684-9696
Mailing Address - Fax:503-684-9892
Practice Address - Street 1:9355 SW MCDONALD ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-5906
Practice Address - Country:US
Practice Address - Phone:503-684-9696
Practice Address - Fax:503-684-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR508637Medicaid