Organization
WOODLAND NURSING INN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY E GRIMES (PRESIDENT)
(925) 855-0881
Entity
Organization
Contact information
Practice address
3721 MT DIABLO BLVD, LAFAYETTE, CA 94549-3538
(925) 284-5544
(925) 284-5673
Mailing address
3 CROW CANYON CT, SAN RAMON, CA 94583-1966
(925) 855-0881
(925) 855-9297
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
332B00000X
Durable Medical Equipment & Medical Supplies
—
CA
332BN1400X
Nursing Facility Supplies (DME)
—
CA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1128360001
NSC NUMBER
CA
05
—
LTC 06469G
—
CA
Enumeration date
08/16/2005
Last updated
11/21/2007
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