Provider Demographics
NPI:1902897424
Name:WOODCREST ASSISTED LIVING LP
Entity Type:Organization
Organization Name:WOODCREST ASSISTED LIVING LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRETTS
Authorized Official - Suffix:
Authorized Official - Credentials:PCH ADMINISTRATOR
Authorized Official - Phone:742-887-3773
Mailing Address - Street 1:1 WOODCREST CIR
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-9539
Mailing Address - Country:US
Mailing Address - Phone:724-887-3773
Mailing Address - Fax:724-887-7659
Practice Address - Street 1:1 WOODCREST CIR
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-9539
Practice Address - Country:US
Practice Address - Phone:724-887-3773
Practice Address - Fax:724-887-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000790310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility