Provider Demographics
NPI:1922094945
Name:UNIVERSITY EXTENDED CARE INC
Entity Type:Organization
Organization Name:UNIVERSITY EXTENDED CARE INC
Other - Org Name:WESTWOOD NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-863-7514
Mailing Address - Street 1:1230 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2142
Mailing Address - Country:US
Mailing Address - Phone:706-828-2512
Mailing Address - Fax:706-828-2514
Practice Address - Street 1:561 UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-863-7514
Practice Address - Fax:706-855-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALTC1036959314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000219359AMedicaid
GA000219359AMedicaid
0755600002Medicare NSC