Provider Demographics
NPI:1306831755
Name:CVW MANAGEMENT INC.
Entity Type:Organization
Organization Name:CVW MANAGEMENT INC.
Other - Org Name:GLENDALE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:VON WALDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-2752
Mailing Address - Street 1:2040 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2226
Mailing Address - Country:US
Mailing Address - Phone:912-354-2752
Mailing Address - Fax:912-352-2038
Practice Address - Street 1:10200 U S HIGHWAY 1 SOUTH
Practice Address - Street 2:
Practice Address - City:WADLEY
Practice Address - State:GA
Practice Address - Zip Code:30477-3864
Practice Address - Country:US
Practice Address - Phone:478-252-3254
Practice Address - Fax:478-252-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-081-372314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000141138AMedicaid
GA11-5679Medicare Oscar/Certification
GA4481250001Medicare NSC