Provider Demographics
NPI:1982780680
Name:WOODLAND COUNTRY MANOR INC
Entity type:Organization
Organization Name:WOODLAND COUNTRY MANOR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:AUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-523-4449
Mailing Address - Street 1:4166 SOMERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45064
Mailing Address - Country:US
Mailing Address - Phone:513-523-4449
Mailing Address - Fax:513-523-7900
Practice Address - Street 1:4166 SOMERVILLE RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45064
Practice Address - Country:US
Practice Address - Phone:513-523-4449
Practice Address - Fax:513-523-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4548314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0161766Medicaid
366109Medicare ID - Type Unspecified
OH0161766Medicaid