Provider Demographics
NPI:1760659338
Name:WOODARD RETIREMENT VILLAGE
Entity Type:Organization
Organization Name:WOODARD RETIREMENT VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:WOODARD
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-734-2889
Mailing Address - Street 1:1019 ROYALL AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2500
Mailing Address - Country:US
Mailing Address - Phone:919-734-2889
Mailing Address - Fax:919-734-7995
Practice Address - Street 1:1019 ROYALL AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2500
Practice Address - Country:US
Practice Address - Phone:919-734-2889
Practice Address - Fax:919-734-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL0096009302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization