Provider Demographics
NPI:1306728977
Name:WOODMORE HOUSE ASSISTED LIVING, INC.
Entity type:Organization
Organization Name:WOODMORE HOUSE ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:JD, LLM
Authorized Official - Phone:443-813-2687
Mailing Address - Street 1:1717 LARGO RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8524
Mailing Address - Country:US
Mailing Address - Phone:240-510-0935
Mailing Address - Fax:240-319-7188
Practice Address - Street 1:1717 LARGO RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8524
Practice Address - Country:US
Practice Address - Phone:240-510-0935
Practice Address - Fax:240-319-7188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility