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General NPI Number Information
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NPI Number | 1922094945
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Entity Type | Organization
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Legal Business Name | UNIVERSITY EXTENDED CARE INC
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 561 UNIVERSITY DRIVE
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City | EVANS
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State | GA
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Zip | 30809
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Country | US
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Telephone | 706-863-7514
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Fax | 706-855-9580
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Provider Business Mailing Address
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Address Line | 1230 WALTON WAY
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City | AUGUSTA
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State | GA
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Zip | 30901-2142
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Country | US
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Telephone | 706-828-2512
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Fax | 706-828-2514
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. KEITH WAYNE AUSTIN
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Credential |
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Telephone | 706-863-7514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | LTC1036959
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License Number State | GA
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