Provider Demographics
NPI:1255582912
Name:WOODENSHOE RETREAT INC.
Entity type:Organization
Organization Name:WOODENSHOE RETREAT INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-775-4453
Mailing Address - Street 1:2560 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-9118
Mailing Address - Country:US
Mailing Address - Phone:386-775-4453
Mailing Address - Fax:386-775-4454
Practice Address - Street 1:2560 SHADY LN
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-9118
Practice Address - Country:US
Practice Address - Phone:386-775-4453
Practice Address - Fax:386-775-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9351310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility