Organization
EBG HEALTH CARE III, INC.
Active
Other names
Woodland Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL L GOURLEY (CHIEF FINANCIAL OFFICER)
(417) 869-5522
Entity
Organization
Contact information
Practice address
1347 E VALLEY WATERMILL ROAD, SPRINGFIELD, MO 65803
(417) 833-1220
(417) 833-5979
Mailing address
1505 E TRAFFICWAY ST, SPRINGFIELD, MO 65802-3174
(417) 869-5522
(417) 831-7729
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
031859
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101492502
—
MO
Enumeration date
06/19/2006
Last updated
01/20/2009
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