Provider Demographics
NPI:1346336435
Name:WESTBURY MEDICAL CARE HOME, INC.
Entity Type:Organization
Organization Name:WESTBURY MEDICAL CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:WESTBURY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:770-775-7832
Mailing Address - Street 1:922 MCDONOUGH RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-1522
Mailing Address - Country:US
Mailing Address - Phone:770-775-7832
Mailing Address - Fax:770-504-9430
Practice Address - Street 1:922 MCDONOUGH RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1522
Practice Address - Country:US
Practice Address - Phone:770-775-7832
Practice Address - Fax:770-504-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-018-173314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00143514AMedicaid
GA00143514AMedicaid