Organization
WOODLAKE NURSING HOME LLC
Active
Other names
Woodlake Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
VEDALIA S FOX (PRESIDENT)
(979) 265-4221
Entity
Organization
Contact information
Practice address
603 E PLANTATION DR, CLUTE, TX 77531-5719
(979) 265-4221
Mailing address
920 RIDGEBROOK RD, SPARKS, MD 21152-9390
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001014699
—
TX
Enumeration date
11/17/2006
Last updated
03/16/2016
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