Provider Demographics
NPI:1891894465
Name:WOODSTOCK CARE CENTER, INC.
Entity Type:Organization
Organization Name:WOODSTOCK CARE CENTER, INC.
Other - Org Name:SPRING MEADOWS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:937-826-3351
Mailing Address - Street 1:1649 PARK RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:OH
Mailing Address - Zip Code:43084-9713
Mailing Address - Country:US
Mailing Address - Phone:937-826-3351
Mailing Address - Fax:937-826-5565
Practice Address - Street 1:1649 PARK RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:OH
Practice Address - Zip Code:43084-9713
Practice Address - Country:US
Practice Address - Phone:937-826-3351
Practice Address - Fax:937-826-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4605313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0352149Medicaid
OH0352149Medicaid