BRANDON WILDE
NPI 1508855115
Skilled Nursing Facility in Evans, GA

Active since October 17, 2005CLIA 11D0938739 · Waiver
4275 OWENS RD, EVANS, GA 30809(706) 868-3526(706) 868-3525 Get Directions Write a Review

NPPES record last updated: June 8, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Brandon Wilde NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRANDON WILDE (NPI 1508855115) is a healthcare organization registered as a skilled nursing facility in Evans, Georgia and active in the NPI registry since October 2005. The organization holds a CLIA Waiver certificate valid through January 13, 2028 and lists Richard Kisner, President/ceo, as its authorized official.

NPPES Registry Identity

NPI1508855115
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameAUGUSTA RESOURCE CENTER ON AGING, INC.
Location Address4275 OWENS RDEvans, GA 30809-3066
Mailing Address4275 Owens RdEvans, GA 30809-3066 · (706) 868-3526 · Fax (706) 868-3525
Fax(706) 868-3525
Organization SubpartYesParent: University Health, Inc.
Authorized OfficialRichard KisnerPresident/ceo · (706) 868-3527
Enumeration DateOctober 17, 2005
Last NPPES UpdateJune 8, 2010
NPI 1508855115 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(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.
4275 OWENS RD, Evans, GA 30809

Other Names 1

Doing Business AsBrandon Wilde

Other Identifiers 1

Medicare OSCAR/certification115524GA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D0938739

Brandon Wilde LLC Dba Pavilion At Brandon Wilde · Evans, GA
Active · expires Jan 13, 2028
CLIA Number11D0938739
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateJanuary 14, 2026
Certificate Expiration DateJanuary 13, 2028
Laboratory DirectorGeorge Pursley
Laboratory Phone(706) 868-9800
Laboratory LocationBrandon Wilde LLC Dba Pavilion At Brandon Wilde4275 Owens Road, Evans, GA 30809
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Skilled Nursing Facility
4275 OWENS RD
EVANS, GA 30809
Skilled Nursing Facility
4275 OWENS RD
EVANS, GA 30809
Speech-Language Pathologist
4275 OWENS RD
EVANS, GA 30809
General Practice
4275 OWENS RD, APT. 518
EVANS, GA 30809

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Augusta Resource Center On Aging, Inc.'s NPI number?

The NPI number for Augusta Resource Center On Aging, Inc. is 1508855115. It was assigned to this organization in the NPPES registry on October 17, 2005. The provider is doing business as Brandon Wilde.

Where is Augusta Resource Center On Aging, Inc. located?

Augusta Resource Center On Aging, Inc. is located at 4275 Owens Rd, Evans, GA 30809. The listed phone number is (706) 868-3526.

What is Augusta Resource Center On Aging, Inc.'s specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Augusta Resource Center On Aging, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D0938739) is associated with this NPI, valid through January 13, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Augusta Resource Center On Aging, Inc. was last updated on June 8, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.