Provider Demographics
NPI:1336136019
Name:WILDWOOD HEALTH CARE, INC.
Entity Type:Organization
Organization Name:WILDWOOD HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-692-6014
Mailing Address - Street 1:184 PINHOOK RD
Mailing Address - Street 2:
Mailing Address - City:TALKING ROCK
Mailing Address - State:GA
Mailing Address - Zip Code:30175-3495
Mailing Address - Country:US
Mailing Address - Phone:706-692-6014
Mailing Address - Fax:706-692-6695
Practice Address - Street 1:184 PINHOOK RD
Practice Address - Street 2:
Practice Address - City:TALKING ROCK
Practice Address - State:GA
Practice Address - Zip Code:30175-3495
Practice Address - Country:US
Practice Address - Phone:706-692-6014
Practice Address - Fax:706-692-6695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-112-1344314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00143547AMedicaid
GA00143547AMedicaid