Provider Demographics
NPI:1750594560
Name:WOODMERE CENTER
Entity type:Organization
Organization Name:WOODMERE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-275-7328
Mailing Address - Street 1:1706 RAYSTON DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5243
Mailing Address - Country:US
Mailing Address - Phone:336-275-7328
Mailing Address - Fax:336-272-6359
Practice Address - Street 1:1706 RAYSTON DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5243
Practice Address - Country:US
Practice Address - Phone:336-275-7328
Practice Address - Fax:336-272-6359
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIGGINS FAMILY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-08
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFCL-041-071Medicaid