Provider Demographics
NPI:1518964550
Name:WOODHAVEN CARE CENTER, LLC
Entity Type:Organization
Organization Name:WOODHAVEN CARE CENTER, LLC
Other - Org Name:WOODHAVEN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:HENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-963-9150
Mailing Address - Street 1:209 SIGMA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2826
Mailing Address - Country:US
Mailing Address - Phone:412-963-9150
Mailing Address - Fax:412-963-6676
Practice Address - Street 1:2400 MCGINLEY RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3541
Practice Address - Country:US
Practice Address - Phone:412-856-4770
Practice Address - Fax:412-856-6856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA233102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035475OtherGATEWAY PROVIDER NO.
PA1385OtherFREEDOM BLUE
PA133776OtherHEALTH ASSURANCE
PA1385OtherSECURITY BLUE
PA2553698OtherAETNA - US HEALTHCARE
PA110120OtherUNISON - MEDPLUS
PA133776OtherADVANTRA
PA1385OtherHIGHMARK BC BS
PA0018363510001Medicaid
PA133776OtherHEALTH AMERICA
PA14021OtherADVANTRA PROVIDER NO.
PA96459OtherMED PLUS PROVIDER NO.
PA14021OtherHEALTH AMERICA/ASSURANCE
PA217012OtherUPMC
PA2553698OtherAETNA - US HEALTHCARE