Healthcare Provider Details

I. General information

NPI: 1780221135
Provider Name (Legal Business Name): WESTWOOD PAC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 STOCKYARD RD
STATESBORO GA
30458-1343
US

IV. Provider business mailing address

101 STOCKYARD RD
STATESBORO GA
30458-1343
US

V. Phone/Fax

Practice location:
  • Phone: 912-764-6005
  • Fax:
Mailing address:
  • Phone: 912-764-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ARI SILBERSTEIN
Title or Position: MEMBER
Credential:
Phone: 631-592-6400