Provider Demographics
NPI:1982655627
Name:ALTHEA WOODLAND, INC.
Entity Type:Organization
Organization Name:ALTHEA WOODLAND, INC.
Other - Org Name:ALTHEA WOODLAND NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED NHA
Authorized Official - Phone:301-434-2646
Mailing Address - Street 1:1000 DALEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-3658
Mailing Address - Country:US
Mailing Address - Phone:301-434-2646
Mailing Address - Fax:301-439-9133
Practice Address - Street 1:1000 DALEVIEW DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-3658
Practice Address - Country:US
Practice Address - Phone:301-434-2646
Practice Address - Fax:301-439-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD837314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD152287600Medicaid
215228Medicare Oscar/Certification