Provider Demographics
NPI:1043256969
Name:WESTBURY CONYERS LLC
Entity type:Organization
Organization Name:WESTBURY CONYERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-228-1228
Mailing Address - Street 1:1420 MILSTEAD RD NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3823
Mailing Address - Country:US
Mailing Address - Phone:770-483-3902
Mailing Address - Fax:770-483-2342
Practice Address - Street 1:1420 MILSTEAD RD NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3823
Practice Address - Country:US
Practice Address - Phone:770-483-3902
Practice Address - Fax:770-483-2342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11221890314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
5100710 001OtherBCBS
GA000143503AMedicaid
5100710 001OtherBCBS