Provider Demographics
NPI:1437212016
Name:NATIONAL ASSISTANCE BUREAU, INC.
Entity Type:Organization
Organization Name:NATIONAL ASSISTANCE BUREAU, INC.
Other - Org Name:WESTSIDE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYGH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-650-8773
Mailing Address - Street 1:1145 HEMBREE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1122
Mailing Address - Country:US
Mailing Address - Phone:770-650-8773
Mailing Address - Fax:770-650-9732
Practice Address - Street 1:WESTSIDE CARE CENTER
Practice Address - Street 2:601 NORTH COLUMBIA ST
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896
Practice Address - Country:US
Practice Address - Phone:618-932-2109
Practice Address - Fax:618-937-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0045732314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL582489411001Medicaid
IL145664Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER