Provider Demographics
NPI:1366715401
Name:WOODLAND HILLS HC NURSING LLC
Entity type:Organization
Organization Name:WOODLAND HILLS HC NURSING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:P
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-964-8974
Mailing Address - Street 1:8701 RILEY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6509
Mailing Address - Country:US
Mailing Address - Phone:501-227-2700
Mailing Address - Fax:501-907-0629
Practice Address - Street 1:8701 RILEY DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6509
Practice Address - Country:US
Practice Address - Phone:501-227-2700
Practice Address - Fax:501-907-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR191596311Medicaid
AR191596311Medicaid