Provider Demographics
NPI:1841640299
Name:CRM OF WARRENTON LLC
Entity type:Organization
Organization Name:CRM OF WARRENTON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
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 1:813 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30828-9105
Mailing Address - Country:US
Mailing Address - Phone:706-465-3328
Mailing Address - Fax:706-465-1119
Practice Address - Street 1:813 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:GA
Practice Address - Zip Code:30828-9105
Practice Address - Country:US
Practice Address - Phone:706-465-3328
Practice Address - Fax:706-465-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
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
115321Medicare Oscar/Certification