Provider Demographics
NPI:1891229241
Name:WOODLAND HOMES DAY PROGRAM,LLC.
Entity Type:Organization
Organization Name:WOODLAND HOMES DAY PROGRAM,LLC.
Other - Org Name:PAPA & NANA'S ADULT DAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:MAXINE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-251-5643
Mailing Address - Street 1:PO BOX 1718
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31034-1718
Mailing Address - Country:US
Mailing Address - Phone:478-251-5643
Mailing Address - Fax:478-932-5817
Practice Address - Street 1:1212 N JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2532
Practice Address - Country:US
Practice Address - Phone:478-251-5643
Practice Address - Fax:478-932-5817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAADC000148261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care