Provider Demographics
NPI:1669732814
Name:WOODLAND CENTERS, INC.
Entity type:Organization
Organization Name:WOODLAND CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:740-446-5500
Mailing Address - Street 1:3086 STATE ROUTE 160
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8409
Mailing Address - Country:US
Mailing Address - Phone:740-446-5500
Mailing Address - Fax:740-441-4402
Practice Address - Street 1:3086 STATE ROUTE 160
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-8409
Practice Address - Country:US
Practice Address - Phone:740-446-5500
Practice Address - Fax:740-441-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0253701Medicaid
OHW09168562Medicare PIN
OHW09168563Medicare PIN
OHW09168561Medicare PIN