Provider Demographics
NPI:1982876454
Name:OCOEE FOUNDATION-CC LLC
Entity Type:Organization
Organization Name:OCOEE FOUNDATION-CC LLC
Other - Org Name:WOODBURY NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLCOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-834-3188
Mailing Address - Street 1:119 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1226
Mailing Address - Country:US
Mailing Address - Phone:615-563-5930
Mailing Address - Fax:615-563-4043
Practice Address - Street 1:119 W HIGH ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1226
Practice Address - Country:US
Practice Address - Phone:615-563-5930
Practice Address - Fax:615-563-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445435Medicaid
TN7440221Medicaid
TN7440221Medicaid