Basic Information
| Provider Information | |||||||||
| NPI: | 1922244979 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASCEND HEALTHCARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HIDDEN ACRES HEALTH CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 OLD ALABAMA RD | ||||||||
| Address2: | SUITE 119-149 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300225860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706190866 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 904 HIDDEN ACRES AVE | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384741039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313795502 | ||||||||
| FaxNumber: | 9313795504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2008 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | COWLEY | ||||||||
| AuthorizedOfficialFirstName: | ALFRED | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7065379052 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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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.