Provider Demographics
NPI:1760451900
Name:WOODLANDS CARE CENTER OF CITRUS COUNTY, INC.
Entity type:Organization
Organization Name:WOODLANDS CARE CENTER OF CITRUS COUNTY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-255-1054
Mailing Address - Street 1:124 W NORVELL BRYANT HWY
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-5105
Mailing Address - Country:US
Mailing Address - Phone:352-249-3100
Mailing Address - Fax:352-746-0748
Practice Address - Street 1:124 W NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-5105
Practice Address - Country:US
Practice Address - Phone:352-249-3100
Practice Address - Fax:352-746-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130471018314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022871100Medicaid
FL106036Medicare ID - Type UnspecifiedPROVIDER NUMBER