Provider Demographics
NPI:1689084790
Name:JAY WYN L.L.C
Entity Type:Organization
Organization Name:JAY WYN L.L.C
Other - Org Name:WOODLAND HILLS MANOR ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MCQUISTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-231-4938
Mailing Address - Street 1:P.O. BOX 102
Mailing Address - Street 2:
Mailing Address - City:FOLLANSBEE
Mailing Address - State:WV
Mailing Address - Zip Code:26062
Mailing Address - Country:US
Mailing Address - Phone:304-527-5400
Mailing Address - Fax:304-527-5455
Practice Address - Street 1:610 NORTH 10TH STREET
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062
Practice Address - Country:US
Practice Address - Phone:304-748-3943
Practice Address - Fax:304-748-3944
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAY WYN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV507574310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility