Active NPI
Brenda Wodarski
- Nursing Home Administrator
- Hudsonville, MI
National Provider Identifier
1043640337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Home Administrator
- License
- AS700317377
- Practice address
- 3109 S Bluff CT
Hudsonville, MI 49426-1580 - Phone
- (616) 209-5029
- NPI assigned
- Nov 22, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Home Administrator | 376G00000X | AS700317377 | MI | Primary |
Addresses
Primary practice location
3109 S Bluff CT
Hudsonville, MI 49426-1580
Mailing address
3761 Bradwood CT NW
Walker, MI 49534-2722
Phone (616) 540-3038
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AS700317377 | MI | MD | Nursing Home Administrator |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Platinum Living LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Assisted Living Facility
- Hudsonville, MI
- NPI 1588094775
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1385078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1385078400000",
"number": "1043640337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3761 BRADWOOD CT NW",
"city": "WALKER",
"state": "MI",
"postal_code": "495342722",
"telephone_number": "616-540-3038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3109 S BLUFF CT",
"city": "HUDSONVILLE",
"state": "MI",
"postal_code": "494261580",
"telephone_number": "616-209-5029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WODARSKI",
"first_name": "BRENDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-22",
"last_updated": "2013-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "376G00000X",
"taxonomy_group": "",
"desc": "Nursing Home Administrator",
"state": "MI",
"license": "AS700317377",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hudsonville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.