Provider Demographics
NPI:1568001527
Name:WOODS MANOR
Entity Type:Organization
Organization Name:WOODS MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-203-4195
Mailing Address - Street 1:409 STEEPLECHASE CT
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-6810
Mailing Address - Country:US
Mailing Address - Phone:856-244-8072
Mailing Address - Fax:856-537-5769
Practice Address - Street 1:1505 S ACADEMY ST
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-3368
Practice Address - Country:US
Practice Address - Phone:856-244-8072
Practice Address - Fax:856-537-5769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODS MANOR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-22
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0568694Medicaid