Organization
PROGRESSIVE LONG TERM CARE, LLC
Active
Other names
Pinewood Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONNY G CRUMP (PRESIDENT)
(478) 892-9171
Entity
Organization
Contact information
Practice address
704 COMMERCE ST, HAWKINSVILLE, GA 31036-1004
(478) 892-9171
(478) 783-2101
Mailing address
PO BOX 1218, HAWKINSVILLE, GA 31036-7218
(478) 892-9171
(478) 783-2101
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1116927
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00142513A
—
GA
Enumeration date
10/19/2005
Last updated
01/03/2008
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