Healthcare Provider Details

I. General information

NPI: 1134165079
Provider Name (Legal Business Name): HLTC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 PROFESSIONAL BOULEVARD
DALTON GA
30720-2628
US

IV. Provider business mailing address

1115 PROFESSIONAL BOULEVARD
DALTON GA
30720-2628
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-4642
  • Fax: 706-226-9785
Mailing address:
  • Phone: 706-226-4642
  • Fax: 706-226-9785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-155-1529
License Number StateGA

VIII. Authorized Official

Name: DENNIS STOUT
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-226-4642