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NPI Code Detail

MEDICARE: WILLOWWOOD PAC LLC

MEDICARE: WILLOWWOOD PAC LLC
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

General Provider Information

NPI Number : 1871130229
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLOWWOOD PAC LLC
Provider Business Mailing 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 :
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 :
Authorized Official
Title or Position : MEMBER
Name : ARI SILBERSTEIN
Credential :
Telephone Number : 631-592-6400
Provider Enumeration Date : 12/04/2019
Last Update Date : 12/04/2019

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Directions to “WILLOWWOOD PAC LLC ” Practice Location

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