Organization
WOODRIDGE OF PONITAC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHALL A MAUER (MANAGER)
(815) 844-2100
Entity
Organization
Contact information
Practice address
120 NORTH DEERFIELD ROAD, PONTIAC, IL 61764
(815) 844-2100
(815) 844-2103
Mailing address
120 NORTH DEERFIELD ROAD, PONTIAC, IL 61764
(815) 844-2100
(815) 844-2103
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
12/17/2008
Last updated
12/17/2008
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