Active NPI
Woodhaven Manor Nursing Home, LLC
- Nursing Facility/Intermediate Care Facility
- Demopolis, AL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Facility/Intermediate Care Facility
- License
- 12619
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4754320S | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- LLC
- 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 DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| Crowne Management, LLC | Operational/Managerial Control | Dec 10, 2009 | |
| Jennifer Jones McInnish Family Dynasty Trust #1 | 5% Or Greater Indirect Ownership Interest | Dec 31, 2016 | |
| Richard Bryan Jones Family Dynasty Trust #1 | 5% Or Greater Indirect Ownership Interest | Dec 31, 2016 | |
| John Todd Wilder | Corporate Director | Dec 5, 2003 | |
| Crowne Operations, Inc | 5% Or Greater Direct Ownership Interest | Nov 1, 2003 | |
| Brandon Taylor | W-2 Managing Employee | Dec 15, 2014 | |
| Marcus F. Manning | Corporate Director | Jun 11, 2015 | |
| Noel Dunnam | Corporate Officer | Jun 11, 2015 | |
| Corporate Director | Jun 11, 2015 | ||
| Richard B. Jones | Corporate Officer | Jun 11, 2015 | |
| Corporate Director | Jun 11, 2015 |
Facilities with the same owner 17
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Nursing Facility/Intermediate Care Facility
- Atmore, AL
- NPI 1740249200
Crowne Management, LLC, Crowne Operations, Inc, Jennifer Jones McInnish Family Dynasty Trust #1, Richard Bryan Jones Family Dynasty Trust #1
-
- Nursing Facility/Intermediate Care Facility
- Alexander City, AL
- NPI 1972562536
Crowne Management, LLC, Crowne Operations, Inc, Jennifer Jones McInnish Family Dynasty Trust #1, Richard Bryan Jones Family Dynasty Trust #1
-
- Skilled Nursing Facility
- Citronelle, AL
- NPI 1730530130
Crowne Management, LLC, Crowne Operations, Inc, Jennifer Jones McInnish Family Dynasty Trust #1, Richard Bryan Jones Family Dynasty Trust #1
-
- Nursing Facility/Intermediate Care Facility
- Eufaula, AL
- NPI 1043279532
Crowne Management, LLC, Crowne Operations, Inc, Jennifer Jones McInnish Family Dynasty Trust #1, Richard Bryan Jones Family Dynasty Trust #1
-
- Nursing Facility/Intermediate Care Facility
- Fort Payne, AL
- NPI 1508825076
Crowne Management, LLC, Crowne Operations, Inc, Jennifer Jones McInnish Family Dynasty Trust #1, Richard Bryan Jones Family Dynasty Trust #1
-
- Nursing Facility/Intermediate Care Facility
- Greenville, AL
- NPI 1053370544
Crowne Management, LLC, Crowne Operations, Inc, Jennifer Jones McInnish Family Dynasty Trust #1, Richard Bryan Jones Family Dynasty Trust #1
-
- Nursing Facility/Intermediate Care Facility
- Mobile, AL
- NPI 1154380632
Crowne Management, LLC, Crowne Operations, Inc, Jennifer Jones McInnish Family Dynasty Trust #1, Richard Bryan Jones Family Dynasty Trust #1
-
- Nursing Facility/Intermediate Care Facility
- Montgomery, AL
- NPI 1679532238
Crowne Management, LLC, Crowne Operations, Inc, Jennifer Jones McInnish Family Dynasty Trust #1, Richard Bryan Jones Family Dynasty Trust #1
-
- Skilled Nursing Facility
- Bay Minette, AL
- NPI 1679280796
Crowne Management, LLC, Crowne Operations, Inc
-
- Skilled Nursing Facility
- Mobile, AL
- NPI 1396068557
Crowne Management, LLC, Crowne Operations, Inc, Jennifer Jones McInnish Family Dynasty Trust #1, Richard Bryan Jones Family Dynasty Trust #1
-
- Skilled Nursing Facility
- Thomasville, AL
- NPI 1023638285
Crowne Management, LLC, Crowne Operations, Inc
-
- Nursing Facility/Intermediate Care Facility
- Monroeville, AL
- NPI 1164481826
Crowne Management, LLC, Crowne Operations, Inc, Jennifer Jones McInnish Family Dynasty Trust #1, Richard Bryan Jones Family Dynasty Trust #1
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Demopolis, AL
- NPI 1578503058
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 Home
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jul 1, 1977
- Medicare certification status
- Active
- Certified beds
- 75
- Chain
- Crowne Health Care
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D0678877 | Woodhaven Manor | Certificate of waiver | Aug 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.