Healthcare Provider Details

I. General information

NPI: 1184653677
Provider Name (Legal Business Name): HLTC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 BURLEYSON RD
DALTON GA
30720-3016
US

IV. Provider business mailing address

1110 BURLEYSON RD
DALTON GA
30720-3016
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-1021
  • Fax: 706-278-0619
Mailing address:
  • Phone: 706-226-1021
  • Fax: 706-278-0619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-155-1530
License Number StateGA

VIII. Authorized Official

Name: JOE WATERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-226-1021