Provider Demographics
NPI:1225012636
Name:WESTSIDE TERRACE, LLC
Entity Type:Organization
Organization Name:WESTSIDE TERRACE, LLC
Other - Org Name:WESTSIDE TERRACE HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-794-1000
Mailing Address - Street 1:501 N WOODBURN DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1995
Mailing Address - Country:US
Mailing Address - Phone:334-794-1000
Mailing Address - Fax:334-794-5287
Practice Address - Street 1:501 N WOODBURN DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1995
Practice Address - Country:US
Practice Address - Phone:334-794-1000
Practice Address - Fax:334-794-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10540314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4757960SMedicaid
AL4757960SMedicaid