Organization
BRANDON WILDE LLC
Active
Other names
The Pavilion at Brandon Wilde
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON C. VICTOR (SR. VP AND TREASURER)
(515) 875-4619
Entity
Organization
Contact information
Practice address
4275 OWENS RD, EVANS, GA 30809-3066
(706) 868-3568
(706) 868-3525
Mailing address
4275 OWENS RD, EVANS, GA 30809-3066
(706) 868-3568
(706) 868-3525
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
11/29/2023
Last updated
11/29/2023
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