Provider Demographics
NPI:1659458412
Name:WOODLAWN, LLC
Entity Type:Organization
Organization Name:WOODLAWN, LLC
Other - Org Name:PAULS VALLEY ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-238-6411
Mailing Address - Street 1:PO BOX 977
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-0977
Mailing Address - Country:US
Mailing Address - Phone:405-282-2600
Mailing Address - Fax:405-282-2610
Practice Address - Street 1:1413 S. CHICKASHA
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075
Practice Address - Country:US
Practice Address - Phone:405-238-6411
Practice Address - Fax:405-238-9278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKDC2501385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-5463Medicare ID - Type Unspecified