Basic Information
| Provider Information | |||||||||
| NPI: | 1861859696 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIDDEN ACRES HEALTHCARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MT. PLEASANT HEALTH & REHAB CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 904 HIDDEN ACRES AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384741039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313795503 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 904 HIDDEN ACRES AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384741039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313795502 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2016 | ||||||||
| LastUpdateDate: | 03/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | HART | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 4235846755 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 181 | TN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | Q028277 | 05 | TN | MEDICAID | Q028276 | 05 | TN | MEDICAID |