Provider Demographics
NPI:1720027469
Name:NAVICENT HEALTH OCONEE, LLC
Entity Type:Organization
Organization Name:NAVICENT HEALTH OCONEE, LLC
Other - Org Name:NAVICENTH HEALTH BALDWIN SKILLED NURSING UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-633-1452
Mailing Address - Street 1:821 N COBB ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2343
Mailing Address - Country:US
Mailing Address - Phone:478-454-3698
Mailing Address - Fax:478-454-3523
Practice Address - Street 1:821 N COBB ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061
Practice Address - Country:US
Practice Address - Phone:478-454-3698
Practice Address - Fax:478-454-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10051608314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00947658AMedicaid
GA00947658AMedicaid