1023040425 NPI number — FLORIDA SENIOR HOUSING COUNCIL INC

Table of content: (NPI 1023040425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023040425 NPI number — FLORIDA SENIOR HOUSING COUNCIL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA SENIOR HOUSING COUNCIL 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 CENTER
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:
1023040425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 N POINT PKWY
Provider Second Line Business Mailing Address:
SUITE 440
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005-5210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-619-0866
Provider Business Mailing Address Fax Number:
770-870-2892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
904 HIDDEN ACRES AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT. PLEASENT
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:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MITTLEIDER
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-619-0866

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0000000181 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X , with the licence number: 651 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 651 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0445374 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7440341 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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