Provider Demographics
NPI:1558527374
Name:WOODMAN ENTERPRISES, LLC
Entity Type:Organization
Organization Name:WOODMAN ENTERPRISES, LLC
Other - Org Name:WOODMAN ADULT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GIN SIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-461-1923
Mailing Address - Street 1:14702 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3735
Mailing Address - Country:US
Mailing Address - Phone:718-461-1923
Mailing Address - Fax:718-461-7617
Practice Address - Street 1:14702 34TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3735
Practice Address - Country:US
Practice Address - Phone:718-461-1923
Practice Address - Fax:718-461-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY590F318311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home