Basic Information
| Provider Information | |||||||||
| NPI: | 1770884942 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOODSTOCK HEALTHCARE GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26691 RICHMOND RD | ||||||||
| Address2: | |||||||||
| City: | BEDFORD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441461421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162925706 | ||||||||
| FaxNumber: | 2162922273 | ||||||||
| Practice Location | |||||||||
| Address1: | 1649 PARK RD | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430849713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378263351 | ||||||||
| FaxNumber: | 9378266515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2010 | ||||||||
| LastUpdateDate: | 04/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | WEISBERG | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | I. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2162925706 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1648N | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.