Provider Demographics
NPI:1427378520
Name:WOODLAND COURT ELDER SERVICES LLC
Entity type:Organization
Organization Name:WOODLAND COURT ELDER SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-539-9700
Mailing Address - Street 1:1102 S CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-8203
Mailing Address - Country:US
Mailing Address - Phone:715-539-9700
Mailing Address - Fax:717-539-9705
Practice Address - Street 1:1102 S CENTER AVE
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-8203
Practice Address - Country:US
Practice Address - Phone:715-539-9700
Practice Address - Fax:717-539-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0009754310400000X
WI0008890310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility