=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174065601
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLD CITY HEALTH & REHAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2016
-----------------------------------------------------
Last Update Date | 01/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 MOORES DR
-----------------------------------------------------
City | DAHLONEGA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30533-0441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-864-3045
-----------------------------------------------------
Fax | 706-864-4535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 MOORES DR
-----------------------------------------------------
City | DAHLONEGA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30533-0441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-864-3045
-----------------------------------------------------
Fax | 706-864-4535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL E WINGET SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 478-994-3669
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------