Provider Demographics
NPI:1740272244
Name:WOODWORTH ENTERPRISES, INC.
Entity type:Organization
Organization Name:WOODWORTH ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-421-2431
Mailing Address - Street 1:1217 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-5125
Mailing Address - Country:US
Mailing Address - Phone:620-421-2431
Mailing Address - Fax:620-423-3432
Practice Address - Street 1:1315 S 15TH ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-5127
Practice Address - Country:US
Practice Address - Phone:620-421-1320
Practice Address - Fax:620-421-2975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODWORTH ENTERPRISES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-19
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN050003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0002346OtherTRADING PARTNER
KS100109820AMedicaid
KS175416Medicare Oscar/Certification
KS0002346OtherTRADING PARTNER