Active NPI
Correctlife Bostick, LLC
- Nursing Facility/Intermediate Care Facility
- Milledgeville, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Facility/Intermediate Care Facility
- Legal business name
- CORRECTLIFE BOSTICK, LLC
- Practice address
- 1 Bostick Cir
Milledgeville, GA 31062-7526 - Phone
- (770) 692-4750
- NPI assigned
- Mar 22, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Carlo A Musso, MD
- Title
- President
- Phone
- (770) 692-4750
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | Primary |
Addresses
Primary practice location
1 Bostick Cir
Milledgeville, GA 31062-7526
Mailing address
3384 Peachtree Rd NE
Suite 700
Atlanta, GA 30326-1181
Phone (770) 692-4750
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160630000890 | GA | Part A Provider - Skilled Nursing Facility | 4385936939 | Practice locations: Milledgeville, GA |
Skilled nursing facility certification: CCN 115732
- Legal name
- CORRECTLIFE BOSTICK, LLC
- Doing business as
- BOSTICK NURSING CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 31, 2017
- Last certification
- May 30, 2024
- Beds
- 280
- Ownership / control type
- Individual
- Organization structure
- LLC
- Incorporated
- Jan 18, 2012 in GA
- Enrollment address
- 1700 Bostick Cir
Milledgeville, GA 31061-3941 - Nursing home name
- BOSTICK NURSING CENTER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Bostick Nursing Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Individual
- Certified
- May 31, 2017
- Medicare certification status
- Active
- Certified beds
- 280
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2119483 | Bostick Nursing Center | Certificate of waiver | Sep 27, 2026 |
National Provider Directory
National Provider DirectoryLocations
3384 Peachtree Rd NE
Ste 700
Atlanta, GA 30326
Phone (770) 626-5740
Ownership & related parties
All disclosed owners & managing parties 8
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Amro Amer | W-2 Managing Employee | Jul 15, 2016 | 25% |
| Stacy Blackburn | Operational/Managerial Control | Jul 15, 2016 | |
| Lynn Junca | Operational/Managerial Control | Jul 15, 2016 | |
| David C Vincent | Operational/Managerial Control | Jul 15, 2016 | |
| Musso Triage 2016 Irrv, Carlo Musso Ttee | 5% Or Greater Indirect Ownership Interest | Jul 15, 2016 | 100% |
| Correctlife, Inc. | 5% Or Greater Direct Ownership Interest | Jul 15, 2016 | 100% |
| Operational/Managerial Control | Jul 15, 2016 | 75% | |
| Carlo Musso | 5% Or Greater Indirect Ownership Interest | Dec 9, 2014 | 100% |
| Vero Health Management LLC | Operational/Managerial Control | Oct 23, 2015 |
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Atlanta, GA
- NPI 1982704300
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458604800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1459900800000",
"number": "1043672819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3384 PEACHTREE RD NE",
"address_2": "SUITE 700",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303261181",
"telephone_number": "770-692-4750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BOSTICK CIR",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310627526",
"telephone_number": "770-692-4750"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CORRECTLIFE BOSTICK, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2016-03-22",
"last_updated": "2016-04-06",
"status": "A",
"authorized_official_last_name": "MUSSO",
"authorized_official_first_name": "CARLO",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "770-692-4750",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Milledgeville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.