Woodenshoe Retreat Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL9351 Issued in FL

Legal business name

WOODENSHOE RETREAT INC.

Doing business as

shady lane

Practice address

2560 Shady LN
Orange City, FL 32763-9118

Phone

(386) 775-4453

Fax

(386) 775-4454

NPI assigned

Sep 30, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Jim Dale Hill

Title

President

Phone

(386) 775-4453

Specialties & licenses 1

Addresses

Other names 1

• shady lane Doing business as

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222732800000",
    "number": "1255582912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 SHADY LN",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327639118",
            "telephone_number": "386-775-4453",
            "fax_number": "386-775-4454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 SHADY LN",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327639118",
            "telephone_number": "386-775-4453",
            "fax_number": "386-775-4454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODENSHOE RETREAT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-30",
        "last_updated": "2008-09-30",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "JIM",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-775-4453",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL9351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "shady lane",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Douglas A Witter, M.D.
• Eve Wittlin-Young, NP-C
• Christopher Lee Wojcik, D.C
• Kristyn Wong
• Lisa M Wood
• Najwa NA-Imah Worthen, DC, MPH, RD
• Michal Jhenna Wright
• Priscille Yancich, NP-C
• Pedro N. Yepes-Hoyos, M.D.
• Andrew Yoon, D.M.D.

• Assisted Living Facility in Orange City, FL
• Providers in Orange City, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2008; 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.