Provider Demographics
NPI:1942214176
Name:WOODSTOCK FACILITY OPERATIONS, LLC
Entity Type:Organization
Organization Name:WOODSTOCK FACILITY OPERATIONS, LLC
Other - Org Name:CONSULATE HEALTH CARE OF WOODSTOCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:USSERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-571-1550
Mailing Address - Street 1:803 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1125
Mailing Address - Country:US
Mailing Address - Phone:540-459-5676
Mailing Address - Fax:540-459-5490
Practice Address - Street 1:803 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1125
Practice Address - Country:US
Practice Address - Phone:540-459-5676
Practice Address - Fax:540-459-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942214176Medicaid
VA1942214176Medicaid