Provider Demographics
NPI:1932393097
Name:WOODGATE PLACE ALF
Entity Type:Organization
Organization Name:WOODGATE PLACE ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:VELMA
Authorized Official - Middle Name:WAJE
Authorized Official - Last Name:TIZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-797-9678
Mailing Address - Street 1:2314 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1511
Mailing Address - Country:US
Mailing Address - Phone:727-797-9678
Mailing Address - Fax:727-796-5282
Practice Address - Street 1:2314 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1511
Practice Address - Country:US
Practice Address - Phone:727-797-9678
Practice Address - Fax:727-796-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320900000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child