Provider Demographics
NPI:1790714871
Name:WOODS HAVEN NURSING CARE & REHABILITATION
Entity Type:Organization
Organization Name:WOODS HAVEN NURSING CARE & REHABILITATION
Other - Org Name:WOODS HAVEN NURSING CARE & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-765-3557
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:POLLOCK
Mailing Address - State:LA
Mailing Address - Zip Code:71467-0159
Mailing Address - Country:US
Mailing Address - Phone:318-765-3557
Mailing Address - Fax:318-765-9862
Practice Address - Street 1:8275 HWY 165
Practice Address - Street 2:
Practice Address - City:POLLOCK
Practice Address - State:LA
Practice Address - Zip Code:71467
Practice Address - Country:US
Practice Address - Phone:318-765-3557
Practice Address - Fax:318-765-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA376314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1515264Medicaid
LA195249Medicare ID - Type UnspecifiedPROVIDER NUMBER
LA195249Medicare Oscar/Certification