Provider Demographics
NPI:1962451856
Name:WOODCREST HEALTHCARE, INC.
Entity Type:Organization
Organization Name:WOODCREST HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:KEYSER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-354-1188
Mailing Address - Street 1:226 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5041
Mailing Address - Country:US
Mailing Address - Phone:318-354-1188
Mailing Address - Fax:318-354-1189
Practice Address - Street 1:226 SOUTH DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5041
Practice Address - Country:US
Practice Address - Phone:318-354-1188
Practice Address - Fax:318-354-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1128619Medicaid
LA194662Medicare Oscar/Certification