Active NPI
University Extended Care, Inc
Doing business as Keysville Nursing Home & Rehab
- Nursing Facility/Intermediate Care Facility
- Keysville, GA
National Provider Identifier
1104398866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Facility/Intermediate Care Facility
- Legal business name
- UNIVERSITY EXTENDED CARE, INC
- Doing business as
- Keysville Nursing Home & Rehab
- Practice address
- 1005 Highway 88 N
Keysville, GA 30816 - Phone
- (706) 547-2591
- Fax
- (706) 547-0492
- NPI assigned
- Dec 19, 2018
- Last updated
- Dec 19, 2018
- Organization subpart
- Yes
- Parent organization
- UNIVERSITY EXTENDED CARE, INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Phyllis Joy Wright
- Title
- Director Decision Support
- Phone
- (706) 828-2445
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | NU | Primary | |
| Skilled Nursing Facility | 314000000X | NU |
Addresses
Primary practice location
1005 Highway 88 N
Keysville, GA 30816
Mailing address
1005 Highway 88 N
Keysville, GA 30816
Phone (706) 547-2591
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000141655A | Medicaid | GA |
Other names 1
- Keysville Nursing Home & Rehab
National Provider Directory
National Provider Directory- Part of
- University Ext Care-Ken
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545177600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1545177600000",
"number": "1104398866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1005 HIGHWAY 88 N",
"city": "KEYSVILLE",
"state": "GA",
"postal_code": "30816",
"telephone_number": "706-547-2591",
"fax_number": "706-547-0492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1005 HIGHWAY 88 N",
"city": "KEYSVILLE",
"state": "GA",
"postal_code": "30816",
"telephone_number": "706-547-2591",
"fax_number": "706-547-0492"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "UNIVERSITY EXTENDED CARE, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "UNIVERSITY EXTENDED CARE, INC",
"enumeration_date": "2018-12-19",
"last_updated": "2018-12-19",
"status": "A",
"authorized_official_last_name": "WRIGHT",
"authorized_official_first_name": "PHYLLIS",
"authorized_official_middle_name": "JOY",
"authorized_official_title_or_position": "DIRECTOR DECISION SUPPORT",
"authorized_official_telephone_number": "706-828-2445"
},
"taxonomies": [
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000141655A",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Keysville Nursing Home & Rehab",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Keysville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.