| NPI | 1508855115 |
|---|---|
| Doing Business As | BRANDON WILDE |
| Entity Type | Organization |
| Authorized Contact | RICHARD KISNER President/CEO 706-868-3527 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2010-06-08 |