Provider Demographics
NPI:1417319021
Name:WOODLAND VILLAGE LLC
Entity type:Organization
Organization Name:WOODLAND VILLAGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-357-7387
Mailing Address - Street 1:2902 TIBBITS AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-7077
Mailing Address - Country:US
Mailing Address - Phone:518-273-2040
Mailing Address - Fax:
Practice Address - Street 1:2902 TIBBITS AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-7077
Practice Address - Country:US
Practice Address - Phone:518-273-2040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY600-F-248310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility