Basic Information
| Provider Information | |||||||||
| NPI: | 1023335155 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MT. PLEASANT CARE CENTERS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HIDDEN ACRES HEALTH CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5895 WINDWARD PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300055203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706190866 | ||||||||
| FaxNumber: | 7706190262 | ||||||||
| Practice Location | |||||||||
| Address1: | 904 HIDDEN ACRES AVE | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384741039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313795502 | ||||||||
| FaxNumber: | 9313795504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2010 | ||||||||
| LastUpdateDate: | 04/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | MITTLEIDER | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/SEC-TREAS/DIR | ||||||||
| AuthorizedOfficialTelephone: | 7706190866 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.