1477584886 NPI number — HLTC, INC.

Table of content: (NPI 1477584886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477584886 NPI number — HLTC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HLTC, 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:
REGENCY PARK HEALTH AND REHABILITATION
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:
1477584886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 BROADRICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30720-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-270-8008
Provider Business Mailing Address Fax Number:
706-270-8248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 BROADRICK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30720-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-270-8008
Provider Business Practice Location Address Fax Number:
706-270-8248
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARRAZANA
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
706-270-8008

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1-155-1591 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51003598 001 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000837207A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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