Basic Information
| Provider Information | |||||||||
| NPI: | 1043209240 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTVIEW NURSING AND REHABILITATION CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 DORSET RD | ||||||||
| Address2: | |||||||||
| City: | PORT WENTWORTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314071517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9129641515 | ||||||||
| FaxNumber: | 9129649490 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 DORSET RD | ||||||||
| Address2: | |||||||||
| City: | PORT WENTWORTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314071517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9129641515 | ||||||||
| FaxNumber: | 9129649490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 12/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | MEADE | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OPERATOR | ||||||||
| AuthorizedOfficialTelephone: | 4783283800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1-025-1577 | GA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 00143536A | 05 | GA | MEDICAID |