Provider Demographics
NPI:1326475138
Name:HEALTHTIQUE WESTWOOD, LLC
Entity Type:Organization
Organization Name:HEALTHTIQUE WESTWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-630-0900
Mailing Address - Street 1:PO BOX 9268
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-9268
Mailing Address - Country:US
Mailing Address - Phone:828-322-8171
Mailing Address - Fax:828-322-3704
Practice Address - Street 1:1001 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6780
Practice Address - Country:US
Practice Address - Phone:850-863-5174
Practice Address - Fax:850-862-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1602096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105395Medicare Oscar/Certification