Woodland Manor Nursing, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

WOODLAND MANOR NURSING, LLC

Doing business as

Eaglewood Care Center

Practice address

2000 Villa Rd
Springfield, OH 45503-1761

Phone

(937) 399-7195

Fax

(937) 399-1474

NPI assigned

Dec 20, 2011

Organization subpart

No

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

Authorized official

Name

Boyd P Gentry

Title

President & Ceo

Phone

(937) 964-8974

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eaglewood Care Center Doing business as

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

{
    "created_epoch": "1324339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324339200000",
    "number": "1609145796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 VILLA RD",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455031761",
            "telephone_number": "937-399-7195",
            "fax_number": "937-399-1474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 VILLA RD",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455031761",
            "telephone_number": "937-399-7195",
            "fax_number": "937-399-1474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAND MANOR NURSING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-20",
        "last_updated": "2011-12-20",
        "status": "A",
        "authorized_official_last_name": "GENTRY",
        "authorized_official_first_name": "BOYD",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "937-964-8974"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0628566",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eaglewood Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carrie Wolfe
• Ronald E Wollum III, PAC
• Kayla Wood
• Stacy Lynn Wood
• Woodland Manor Limited Partnership (Eaglewood Village Care Center)
• Amanda Lynn Woodruff
• Angela Woods
• Deana Marie Woodward
• Thomas Melvin Woolery
• Melanie Lynn Woosley, P.T.

• Skilled Nursing Facility in Springfield, OH
• Providers in Springfield, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; 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.