Provider Demographics
NPI:1912931254
Name:WOODLAWN MANOR, INC.
Entity Type:Organization
Organization Name:WOODLAWN MANOR, INC.
Other - Org Name:THE OAKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-361-9555
Mailing Address - Street 1:PO BOX 3068
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-3068
Mailing Address - Country:US
Mailing Address - Phone:318-361-9555
Mailing Address - Fax:318-361-0740
Practice Address - Street 1:1000 MCKEEN PL
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-361-9555
Practice Address - Fax:318-361-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA388314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1515736Medicaid
LA1515736Medicaid