Provider Demographics
NPI:1972572709
Name:WOODLANDS CARE CENTER OF ALACHUA COUNTY, INC
Entity Type:Organization
Organization Name:WOODLANDS CARE CENTER OF ALACHUA COUNTY, INC
Other - Org Name:WOODLAND CARE CENTER OF ALACHUA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHET
Authorized Official - Middle Name:
Authorized Official - Last Name:MALANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-333-0600
Mailing Address - Street 1:7207 SW 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607
Mailing Address - Country:US
Mailing Address - Phone:352-333-0600
Mailing Address - Fax:352-331-2974
Practice Address - Street 1:7207 SW 24TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-333-0600
Practice Address - Fax:352-331-7752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130471021314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025557200Medicaid
FL106046Medicare ID - Type UnspecifiedPROVIDER NUMBER