Provider Demographics
NPI:1194942649
Name:WESTCARE GEORGIA
Entity type:Organization
Organization Name:WESTCARE GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-490-6767
Mailing Address - Street 1:PO BOX 12019
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-2019
Mailing Address - Country:US
Mailing Address - Phone:727-490-6767
Mailing Address - Fax:727-835-0573
Practice Address - Street 1:827 PRYOR ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-1016
Practice Address - Country:US
Practice Address - Phone:404-761-7485
Practice Address - Fax:404-761-8427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC10000012118322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children