Provider Demographics
NPI:1972513828
Name:WILDEWOOD DOWNS RETIREMENT LLC
Entity Type:Organization
Organization Name:WILDEWOOD DOWNS RETIREMENT LLC
Other - Org Name:WILDEWOOD DOWNS NURSING AND REHABILITATION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:REIMBURSEMENT AR MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-788-5115
Mailing Address - Street 1:1001 WILDEWOOD DOWNS CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4434
Mailing Address - Country:US
Mailing Address - Phone:803-788-5115
Mailing Address - Fax:803-788-5247
Practice Address - Street 1:1001 WILDEWOOD DOWNS CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4434
Practice Address - Country:US
Practice Address - Phone:803-788-5115
Practice Address - Fax:803-788-5247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-914314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC42-5385Medicare ID - Type Unspecified