Provider Demographics
NPI:1366866899
Name:C R OF THOMASVILLE LLC
Entity Type:Organization
Organization Name:C R OF THOMASVILLE LLC
Other - Org Name:THOMASVILLE HEALTH & REHAB, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINGET
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:478-994-3669
Mailing Address - Street 1:120 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-2507
Mailing Address - Country:US
Mailing Address - Phone:229-225-1049
Mailing Address - Fax:229-226-3128
Practice Address - Street 1:120 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-2507
Practice Address - Country:US
Practice Address - Phone:229-225-1049
Practice Address - Fax:229-226-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
115427Medicare Oscar/Certification