THE PAVILION AT BRANDON WILDE – NPI #1821580440
Skilled Nursing Facility

(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

THE PAVILION AT BRANDON WILDE is a skilled nursing facility (SNF) located in EVANS, GA. NPPES has assigned the NPI number 1821580440 to THE PAVILION AT BRANDON WILDE on May 30, 2018. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “THE PAVILION AT BRANDON WILDE” is a dba name, the actual legal business name for this organization is LCS BRANDON WILDE LLC. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 314000000X from the Health Care Provider Taxonomy code set, which is classified as Skilled Nursing Facility.

The NPI profile was previously updated about 7 years ago on Jun 19, 2019. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for THE PAVILION AT BRANDON WILDE below.

NPI Profile for
LCS BRANDON WILDE LLC

NPI Number
1821580440
Enumeration Date

(more than 8 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
LCS BRANDON WILDE LLC
Doing Business As (dba): THE PAVILION AT BRANDON WILDE
Primary location
4275 OWENS RD
EVANS, GA 30809
Phone: (706) 868-9800 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
DIANE BRIDGEWATER
MANAGER OF MANAGING MEMBER
Phone: (515) 875-4500
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
314000000X
- Skilled Nursing Facility (Primary)
GA 1-036-2130
310400000X
- Assisted Living Facility

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.