Organization
WOODSIDE HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISAIAH A TEASLEY (CEO)
(240) 750-0045
Entity
Organization
Contact information
Practice address
4309 KENWOOD DR, WOODBRIDGE, VA 22193-5282
(240) 750-0045
Mailing address
1010 SOUTHERN NIGHT LN, GAITHERSBURG, MD 20879-3268
(240) 750-0045
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
08041139
VA
Other
Enumeration date
04/25/2016
Last updated
04/25/2016
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