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Contact Information

LCS BRANDON WILDE LLC
4275 OWENS RD
EVANS, GA30809
 Phone: 706-868-9800
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Assisted Living Facility

310400000X
Indicates primary specialty

NPI Profile & details for LCS BRANDON WILDE LLC

NPI Number 1821580440
LBN Legal business name LCS BRANDON WILDE LLC
Authorized official DIANE BRIDGEWATER - (MANAGER OF MANAGING MEMBER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/30/2018
Last updated 06/19/2019 - About 7 years ago
Identifiers
GA License # 1-036-2130
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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