Forum Group at Wildwood Park Nursing & Rehabilitation Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

10631819 Issued in GA

Legal business name

FORUM GROUP AT WILDWOOD PARK NURSING & REHABILITATION CENTER, LLC

Practice address

2611 Wildwood Dr
Brunswick, GA 31520-4250

Phone

(912) 264-1434

Fax

(912) 466-9604

NPI assigned

Oct 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. George Dalyn Houser, JD

Title

Manager

Phone

(706) 291-8600

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801978499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 WATER PL SE",
            "address_2": "SUITE 206",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303392006",
            "telephone_number": "678-213-2700",
            "fax_number": "678-213-2705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 WILDWOOD DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204250",
            "telephone_number": "912-264-1434",
            "fax_number": "912-466-9604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORUM GROUP AT WILDWOOD PARK NURSING & REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOUSER",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "DALYN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "706-291-8600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "10631819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Flournoy
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• Doris Joanne Forrest, NCTMB
• Foster Love Ministries
• Coretta Foster
• Evan Hamilton Fountain, M.D.
• Chandler Fox, DPT
• Jamya Frazier

• Skilled Nursing Facility in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.