1023335155 NPI number — MT. PLEASANT CARE CENTERS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023335155 NPI number — MT. PLEASANT CARE CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MT. PLEASANT CARE CENTERS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HIDDEN ACRES HEALTH CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023335155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5895 WINDWARD PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005-5203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-619-0866
Provider Business Mailing Address Fax Number:
770-619-0262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
904 HIDDEN ACRES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38474-1039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-379-5502
Provider Business Practice Location Address Fax Number:
931-379-5504
Provider Enumeration Date:
04/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MITTLEIDER
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/SEC-TREAS/DIR
Authorized Official Telephone Number:
770-619-0866

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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