Provider Demographics
NPI:1154029726
Name:WOODSIDE PARK MD OPCO
Entity type:Organization
Organization Name:WOODSIDE PARK MD OPCO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:PANETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-270-4200
Mailing Address - Street 1:7525 CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5715
Mailing Address - Country:US
Mailing Address - Phone:301-270-4200
Mailing Address - Fax:
Practice Address - Street 1:7525 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5715
Practice Address - Country:US
Practice Address - Phone:301-270-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility