Provider Demographics
NPI:1396590634
Name:113 N SENIOR CARE CENTER LLC
Entity type:Organization
Organization Name:113 N SENIOR CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:OTTO
Authorized Official - Last Name:WOODRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-567-1150
Mailing Address - Street 1:7605 BLANTON RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551-3036
Mailing Address - Country:US
Mailing Address - Phone:757-567-1150
Mailing Address - Fax:
Practice Address - Street 1:113 N AVENIDA DE SAN RAMON
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2111
Practice Address - Country:US
Practice Address - Phone:520-546-9132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility