Provider Demographics
NPI:1912917956
Name:WOODRIDGE ESTATES, L.L.C.
Entity Type:Organization
Organization Name:WOODRIDGE ESTATES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
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:620-421-4700
Mailing Address - Fax:620-423-3432
Practice Address - Street 1:329 KAY LN
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-3501
Practice Address - Country:US
Practice Address - Phone:620-421-4700
Practice Address - Fax:620-421-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN-050-011310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility