NPIMap

Organization Active NPI

Woodland Residential Services, Inc.

  • Nursing Facility/Intermediate Care Facility
  • Woodland, CA
National Provider Identifier
1124237094
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
Legal business name
WOODLAND RESIDENTIAL SERVICES, INC.
Practice address
1215 Evergreen Way
Woodland, CA 95695-4353
Phone
(530) 406-0333
NPI assigned
May 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Parminder Kajley
Title
Administrator
Phone
(530) 406-0333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X CA Primary

Addresses

Primary practice location

1215 Evergreen Way
Woodland, CA 95695-4353

Mailing address

1381 E Gum Ave
Woodland, CA 95776-4275
Phone (530) 406-0333

Other names 1

  • Evergreen Program Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G100

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WRS INC EVERGREEN PROGRAM
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Apr 8, 1997
Last certification
Mar 13, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
1215 Evergreen Way
Woodland, CA 95695

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2243484Woodland Residential Services1215 Evergreen Way, Woodland, CA 95695Certificate of waiverNov 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Elliot Program7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124237094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1381 E GUM AVE",
            "city": "WOODLAND",
            "state": "CA",
            "postal_code": "957764275",
            "telephone_number": "530-406-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 EVERGREEN WAY",
            "city": "WOODLAND",
            "state": "CA",
            "postal_code": "956954353",
            "telephone_number": "530-406-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAND RESIDENTIAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KAJLEY",
        "authorized_official_first_name": "PARMINDER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "530-406-0333"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Woodland, CA

Sources for this page

Verify at the official NPI Registry.