Organization
LCS BRANDON WILDE LLC
Active
Other names
The Pavilion at Brandon Wilde
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE C BRIDGEWATER (MANAGER OF MANAGING MEMBER)
(515) 875-4500
Entity
Organization
Contact information
Practice address
4275 OWENS RD, EVANS, GA 30809
(706) 868-9800
Mailing address
4275 OWENS RD, EVANS, GA 30809-3066
(706) 868-9800
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
314000000X
Skilled Nursing Facility
Primary
1-036-2130
GA
Other
Enumeration date
05/30/2018
Last updated
06/19/2019
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