Organization Active NPI

Woodhaven Manor Nursing Home, LLC

  • Nursing Facility/Intermediate Care Facility
  • Demopolis, AL
National Provider Identifier
1477512952
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
12619 Issued in AL
Legal business name
WOODHAVEN MANOR NURSING HOME, LLC
Practice address
105 W Windsor St
Demopolis, AL 36732-3617
Phone
(334) 289-2741
Fax
(334) 289-0416
NPI assigned
Mar 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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

Authorized official

Name
Noel Dunnam
Title
Cfo
Phone
(251) 743-3609

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 12619 AL Primary

Addresses

Primary practice location

105 W Windsor St
Demopolis, AL 36732-3617

Mailing address

501 Whetstone St
Monroeville, AL 36460-2615
Phone (251) 743-3609

Other identifiers 1

IdentifierTypeStateIssuer
4754320SMedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031203000548 AL Part A Provider - Skilled Nursing Facility 0143125153 Practice locations: Demopolis, AL

Skilled nursing facility certification: CCN 015177

Legal name
WOODHAVEN MANOR NURSING HOME, LLC
Doing business as
WOODHAVEN MANOR
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1977
Last certification
Mar 2, 2022
Beds
75
Ownership / control type
Corporation
Multi-facility organization
CROWNE HEALTH CARE
Most recent change of ownership
Nov 1, 2003
Organization structure
LLCProprietary
Incorporated
Sep 15, 2003 in AL
Enrollment address
105 W Windsor St
Demopolis, AL 36732-3617
Nursing home name
WOODHAVEN MANOR NURSING HOME
Affiliated entity
CROWNE HEALTH CARE

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Crowne Management, LLC Organization, Monroeville, AL LLC Operational/Managerial Control Dec 10, 2009
Jennifer Jones McInnish Family Dynasty Trust #1 Organization, Monroeville, AL 5% Or Greater Indirect Ownership Interest Dec 31, 2016
Richard Bryan Jones Family Dynasty Trust #1 Organization, Monroeville, AL 5% Or Greater Indirect Ownership Interest Dec 31, 2016
John Todd Wilder Individual Corporate Director Dec 5, 2003
Crowne Operations, Inc Organization, Monroeville, AL Corporation 5% Or Greater Direct Ownership Interest Nov 1, 2003
Brandon Taylor Individual W-2 Managing Employee Dec 15, 2014
Marcus F. Manning Individual Corporate Director Jun 11, 2015
Noel Dunnam Individual Corporate OfficerCfo/Secretary Jun 11, 2015
Corporate DirectorCfo/Secretary Jun 11, 2015
Richard B. Jones Individual Corporate OfficerCeo/Vice President Jun 11, 2015
Corporate DirectorCeo/Vice President Jun 11, 2015

Facilities with the same owner 17

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 17

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Woodhaven Manor Nursing HomeCCN 015177
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 1, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7570.9 residents per day on average
Chain
Crowne Health Care18 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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
01D0678877Woodhaven Manor105 W Windsor, Demopolis, AL 36732Certificate of waiverAug 31, 2026

NPI Registry JSON

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1477512952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 WHETSTONE ST",
            "city": "MONROEVILLE",
            "state": "AL",
            "postal_code": "364602615",
            "telephone_number": "251-743-3609",
            "fax_number": "251-575-5618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W WINDSOR ST",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "367323617",
            "telephone_number": "334-289-2741",
            "fax_number": "334-289-0416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODHAVEN MANOR NURSING HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-22",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "DUNNAM",
        "authorized_official_first_name": "NOEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "251-743-3609"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "AL",
            "license": "12619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4754320S",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Demopolis, AL

Sources for this page

Verify at the official NPI Registry.