Provider Demographics
NPI:1023055902
Name:WOODLAND PARK HEALTHCARE CENTER, INC.
Entity type:Organization
Organization Name:WOODLAND PARK HEALTHCARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-805-1474
Mailing Address - Street 1:300 GLEED AVE
Mailing Address - Street 2:THE PARK ASSOCIATES, INC.
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2980
Mailing Address - Country:US
Mailing Address - Phone:716-652-2820
Mailing Address - Fax:716-655-2320
Practice Address - Street 1:451 BROAD ST
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-1424
Practice Address - Country:US
Practice Address - Phone:716-945-1800
Practice Address - Fax:716-945-5867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0433302N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8UOtherINDEPENDENT HEALTH
NY000000340000OtherBLUE CROSS & BLUE SHIELD
NY00011473901OtherUNIVERA
NY01660902Medicaid
NY335534OtherMEDICARE
NY335534001Medicare Oscar/Certification
NYRB2191Medicare PIN
NY335534Medicare Oscar/Certification
NYBA1016Medicare PIN