- Enrollment id
- O20150224001615
- Enrollment state
- GA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1235528357
- Multiple npi flag
- N
- Ccn
- 115706
- Associate id
- 4183940836
- Organization name
- C.R. OF WILDWOOD, LLC
- Doing business as name
- WILDWOOD HEALTH AND REHAB
- Incorporation date
- 2014-10-22
- Incorporation state
- GA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- WILDWOOD HEALTH AND REHAB
- Affiliation entity name
- C. ROSS MANAGEMENT
- Affiliation entity id
- 95
- Address line 1
- 184 PINHOOK RD
- City
- TALKING ROCK
- State
- GA
- Zip code
- 301753495