Organization
LTC HEALTHCARE OF STATESBORO INC
Active
Other names
WestWood Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT HAGAN (PRESIDENT)
(770) 993-4000
Entity
Organization
Contact information
Practice address
101 STOCKYARD RD, STATESBORO, GA 30458-1343
(912) 764-6005
(912) 764-4099
Mailing address
995 CANTON ST STE 100, ROSWELL, GA 30075-4240
(770) 993-4000
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000370F62A
—
GA
Enumeration date
08/10/2005
Last updated
07/18/2019
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