Provider Demographics
NPI:1659560837
Name:C WOOD
Entity Type:Organization
Organization Name:C WOOD
Other - Org Name:C-WOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:WATFORD
Authorized Official - Last Name:CHAMBLEE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:252-794-6563
Mailing Address - Street 1:117 COOPER HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-8505
Mailing Address - Country:US
Mailing Address - Phone:252-794-6563
Mailing Address - Fax:
Practice Address - Street 1:117 COOPER HILL RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-8505
Practice Address - Country:US
Practice Address - Phone:252-794-6563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities