GW SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

GW SNF LLC

Practice address

41 N Fifth St
Glenwood, GA 30428-3701

Phone

(912) 523-5102

Fax

(912) 523-5704

NPI assigned

May 13, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bruce E Wertheim

Title

Manager

Phone

(813) 347-9888

Specialties & licenses 1

Addresses

Other names 1

• Glenwood Healthcare Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Todd Peacock, M.D.

  • Internal Medicine Physician
  • Eastman, GA
  • NPI 1487636742
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1598111007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 869",
            "address_2": "41 N FIFTH ST",
            "city": "GLENWOOD",
            "state": "GA",
            "postal_code": "304280869",
            "telephone_number": "912-523-5102",
            "fax_number": "912-523-5704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 N FIFTH ST",
            "city": "GLENWOOD",
            "state": "GA",
            "postal_code": "304283701",
            "telephone_number": "912-523-5102",
            "fax_number": "912-523-5704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GW SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-13",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "WERTHEIM",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "813-347-9888"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenwood Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Glenwood Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Freds Stores of Tennessee Inc
• Glenwood Drug ,Inc Dba Glenwood Pharmacy
• Glenwood Healthcare, LLC
• Glenwood Opco LLC
• Mark Griffis, MD
• Anthony Junco Jr., M.D.
• Lower Oconee Community Hospital Inc
• Lower Oconee Community Hospital Inc
• Lower Oconee Community Hospital Pharmacy
• Lower Oconee Community Hospital, Inc

• All providers in Glenwood, GA
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.