Organization
PROGRESSIVE LONG TERM CARE
Active
Other names
Pinewood Manor Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD G CRUMP (PRESIDENT)
(478) 783-1623
Entity
Organization
Contact information
Practice address
704 COMMERCE ST, HAWKINSVILLE, GA 31036-1004
(478) 783-4988
Mailing address
P O BOX 1218, PROGRESSIVE HEALTH CARE PINEWOOD MANOR NH, HAWKINSVILLE, GA 31036
(478) 783-4988
Taxonomy
Speciality
Code
Description
License number
State
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000142513B
—
GA
Enumeration date
06/27/2007
Last updated
04/10/2009
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