LTC Healthcare of Statesboro Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LTC HEALTHCARE OF STATESBORO INC

Doing business as

WestWood Nursing Center

Practice address

101 Stockyard Rd
Statesboro, GA 30458-1343

Phone

(912) 764-6005

Fax

(912) 764-4099

NPI assigned

Aug 10, 2005

Organization subpart

No

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

Authorized official

Name

Robert Hagan

Title

President

Phone

(770) 993-4000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• WestWood Nursing Center Doing business as

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1700888740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 CANTON ST STE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300754240",
            "telephone_number": "770-993-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 STOCKYARD RD",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304581343",
            "telephone_number": "912-764-6005",
            "fax_number": "912-764-4099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTC HEALTHCARE OF STATESBORO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-10",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "HAGAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-993-4000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000370F62A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WestWood Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WestWood Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• LTC at Forest Heights Pharmacy
• Katrina Katrice Luke, ED.D, CPCS, LPC, NCC
• Tatiyana Luke, APRN
• Amy Luna, PH.D.
• Sarah Bell Lusted, NP
• Tammy Lynn, M.ED., CCC-SLP

• Skilled Nursing Facility in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.