Healthcare Provider Details

I. General information

NPI: 1104171420
Provider Name (Legal Business Name): WEAVERS BUSINESS SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E TELEPHONE ST 104 E TELEPHONE ST
SYLVANIA GA
30467-1959
US

IV. Provider business mailing address

803 W OGEECHEE ST
SYLVANIA GA
30467-8696
US

V. Phone/Fax

Practice location:
  • Phone: 912-564-2513
  • Fax: 912-564-2750
Mailing address:
  • Phone: 912-564-1118
  • Fax: 912-564-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateGA

VIII. Authorized Official

Name: MS. TERESA B WEAVER
Title or Position: PRESIDENT
Credential:
Phone: 912-978-1210