Provider Demographics
NPI:1336164250
Name:WOODVILLE HOME HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:WOODVILLE HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:L
Authorized Official - Middle Name:J
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-888-3421
Mailing Address - Street 1:451 BANK ST
Mailing Address - Street 2:P.O. BOX 813
Mailing Address - City:WOODVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39669-6000
Mailing Address - Country:US
Mailing Address - Phone:601-888-3715
Mailing Address - Fax:601-888-7042
Practice Address - Street 1:451 BANK ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:MS
Practice Address - Zip Code:39669-6000
Practice Address - Country:US
Practice Address - Phone:601-888-3715
Practice Address - Fax:601-888-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1019880001Medicare NSC