Provider Demographics
NPI:1710018684
Name:WOODWARD RESOURCE CENTER
Entity Type:Organization
Organization Name:WOODWARD RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-438-3622
Mailing Address - Street 1:1251 334TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:IA
Mailing Address - Zip Code:50276-7509
Mailing Address - Country:US
Mailing Address - Phone:515-438-2600
Mailing Address - Fax:515-438-3122
Practice Address - Street 1:1251 334TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:IA
Practice Address - Zip Code:50276-7509
Practice Address - Country:US
Practice Address - Phone:515-438-2600
Practice Address - Fax:515-438-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080069315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0880088Medicaid