Provider Demographics
NPI:1659377414
Name:WOODLAND VILLAGE INC
Entity Type:Organization
Organization Name:WOODLAND VILLAGE INC
Other - Org Name:WOODLANDS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:920-842-4132
Mailing Address - Street 1:425 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:SURING
Mailing Address - State:WI
Mailing Address - Zip Code:54174
Mailing Address - Country:US
Mailing Address - Phone:920-842-4132
Mailing Address - Fax:920-842-4133
Practice Address - Street 1:425 MANOR DR
Practice Address - Street 2:
Practice Address - City:SURING
Practice Address - State:WI
Practice Address - Zip Code:54174-9182
Practice Address - Country:US
Practice Address - Phone:920-842-4132
Practice Address - Fax:920-842-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1017251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41536700Medicaid
527275Medicare PIN
WI527275Medicare ID - Type Unspecified