Woodland Adult Center, LLC

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

WOODLAND ADULT CENTER, LLC

Practice address

101 Market St
Woodland, MS 39776-9105

Phone

(662) 456-0111

Fax

(662) 456-0111

NPI assigned

Aug 30, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Jerry SullivanNPI 1457409807

Title

Owner

Phone

(662) 456-0133

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Jerry Sullivan, CFNP

  • Family Nurse Practitioner
  • Woodland, MS
  • NPI 1457409807
  NPD (past) Authorized official

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

{
    "created_epoch": "1504051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1578081410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 186",
            "city": "WOODLAND",
            "state": "MS",
            "postal_code": "397760186",
            "telephone_number": "662-456-0133",
            "fax_number": "662-456-7335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MARKET ST",
            "city": "WOODLAND",
            "state": "MS",
            "postal_code": "397769105",
            "telephone_number": "662-456-0111",
            "fax_number": "662-456-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAND ADULT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-30",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-456-0133",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0114346",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Foot Solutions LLC
• Jerry Sullivan, CFNP
• Jessica Sullivan, CFNP
• Woodland Clinic LLC

• Adult Day Care Clinic/Center in Woodland, MS
• Providers in Woodland, MS by specialty
• Adult Day Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.