Provider Demographics
NPI:1104527597
Name:WOODRUFF, DONALD ALFRED III
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:ALFRED
Last Name:WOODRUFF
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5371 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1501
Mailing Address - Country:US
Mailing Address - Phone:216-532-4811
Mailing Address - Fax:
Practice Address - Street 1:5371 HOLLY RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1501
Practice Address - Country:US
Practice Address - Phone:216-532-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1848112253Z00000X
OH1828117320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care