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NPI Code Detail

MEDICARE: WILLOWWOOD NURSING CENTER INC

MEDICARE: WILLOWWOOD NURSING CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184626160
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLOWWOOD NURSING CENTER INC
Provider Business Mailing Address
First Line : 995 CANTON ST STE 100
Second Line :
City : ROSWELL
State : GA
Zip : 30075-4240
Country : US
Telephone Number : 770-993-4000
Fax Number :
Provider Business Practice Location Address
First Line : 4595 CANTRELL RD
Second Line :
City : FLOWERY BRANCH
State : GA
Zip : 30542-3304
Country : US
Telephone Number : 770-967-2070
Fax Number : 770-967-4312
Authorized Official
Title or Position : PRESIDENT
Name : ROBERT HAGAN
Credential :
Telephone Number : 770-993-4000
Provider Enumeration Date : 08/10/2005
Last Update Date : 07/18/2019

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Directions to “WILLOWWOOD NURSING CENTER INC ” Practice Location

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