Provider Demographics
NPI:1730348764
Name:WOODLAND RESIDENTIAL SERVICES
Entity type:Organization
Organization Name:WOODLAND RESIDENTIAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PARMINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAJLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-835-8269
Mailing Address - Street 1:1381 E GUM AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-4275
Mailing Address - Country:US
Mailing Address - Phone:530-419-0059
Mailing Address - Fax:
Practice Address - Street 1:40145 BEST RANCH ROAD
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776
Practice Address - Country:US
Practice Address - Phone:530-661-9030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000698313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80288GMedicaid