1255966081 NPI number — WESTMINSTER PRESBYTERIAN HOMES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255966081 NPI number — WESTMINSTER PRESBYTERIAN HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTMINSTER PRESBYTERIAN HOMES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255966081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 926
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUITMAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31643-0926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-263-6106
Provider Business Mailing Address Fax Number:
229-263-6195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 LIVE OAK LN
Provider Second Line Business Practice Location Address:
BUILDING 100
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-301-4906
Provider Business Practice Location Address Fax Number:
706-739-7516
Provider Enumeration Date:
03/12/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ARRENDALE
Authorized Official First Name:
DIANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
229-263-6194

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3104A0630X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 313M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 115775 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1255966081 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: LTC001014 . This is a "GEORGIA NURSING HOME PERMIT" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: ALC000684 . This is a "GEORGIA ASSISTED LIVING PERMIT" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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