NPIMap

Organization Active NPI

Progressive Long Term Care, LLC

Doing business as Pinewood Manor

  • Skilled Nursing Facility
  • Hawkinsville, GA
National Provider Identifier
1114916426
Registry record updated Jan 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1116927 Issued in GA
Legal business name
PROGRESSIVE LONG TERM CARE, LLC
Doing business as
Pinewood Manor
Practice address
704 Commerce St
Hawkinsville, GA 31036-1004
Phone
(478) 892-9171
Fax
(478) 783-2101
NPI assigned
Oct 19, 2005
Last updated
Jan 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ronny G Crump
Title
President
Phone
(478) 892-9171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1116927 GA Primary

Addresses

Primary practice location

704 Commerce St
Hawkinsville, GA 31036-1004

Mailing address

PO Box 1218
Hawkinsville, GA 31036-7218
Phone (478) 892-9171

Other identifiers 1

IdentifierTypeStateIssuer
00142513AMedicaidGA

Other names 1

  • Pinewood Manor Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hal London MD17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1114916426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1218",
            "city": "HAWKINSVILLE",
            "state": "GA",
            "postal_code": "310367218",
            "telephone_number": "478-892-9171",
            "fax_number": "478-783-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 COMMERCE ST",
            "city": "HAWKINSVILLE",
            "state": "GA",
            "postal_code": "310361004",
            "telephone_number": "478-892-9171",
            "fax_number": "478-783-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE LONG TERM CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-19",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "CRUMP",
        "authorized_official_first_name": "RONNY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "478-892-9171",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "1116927",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00142513A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pinewood Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hawkinsville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.