Woodman Healthcare Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

920000067 Issued in CA

Legal business name

WOODMAN HEALTHCARE CENTER LLC

Doing business as

Country Villa Woodman Healthcare Center

Practice address

13524 Sherman Way
Van Nuys, CA 91405-2830

Phone

(323) 596-2145

Fax

(323) 596-4645

NPI assigned

Apr 11, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Stephen Reissman

Title

Ceo/Chairman

Phone

(310) 574-3733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Villa Woodman Healthcare Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360195200000",
    "number": "1063778389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5120 W GOLDLEAF CIR STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900561297",
            "telephone_number": "323-596-2145",
            "fax_number": "323-596-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13524 SHERMAN WAY",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914052830",
            "telephone_number": "323-596-2145",
            "fax_number": "323-596-4645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODMAN HEALTHCARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-11",
        "last_updated": "2013-02-07",
        "status": "A",
        "authorized_official_last_name": "REISSMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CEO/CHAIRMAN",
        "authorized_official_telephone_number": "310-574-3733",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "920000067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05712J",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Villa Woodman Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eric Eugene Wong, MD
• Ivan Ho-Bun Wong, MD
• Tina Wong, PHARM.D
• Nam Woo
• Bonnie Lou Wood
• Woodman Medical Care and Clinic
• Woodvic Medical Care and Clinic
• Woodvic Medical Care and Clinic, Corp
• Woodvic Medical Management, Inc
• Samuel Grayson Woolf

• Skilled Nursing Facility in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 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.

Verify at the official NPI Registry.