Provider Demographics
NPI:1225042724
Name:COOK MANAGEMENT SERVICES INC
Entity Type:Organization
Organization Name:COOK MANAGEMENT SERVICES INC
Other - Org Name:WRIGHTSVILLE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:BUFORD
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-868-7406
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-0209
Mailing Address - Country:US
Mailing Address - Phone:478-864-2286
Mailing Address - Fax:478-864-1536
Practice Address - Street 1:337 W COURT ST
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096-5221
Practice Address - Country:US
Practice Address - Phone:478-864-2286
Practice Address - Fax:478-864-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-083-770314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000143602AMedicaid
GA115406Medicare Oscar/Certification