Healthcare Provider Details

I. General information

NPI: 1477584886
Provider Name (Legal Business Name): HLTC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 BROADRICK DR
DALTON GA
30720-2503
US

IV. Provider business mailing address

1212 BROADRICK DR
DALTON GA
30720-2503
US

V. Phone/Fax

Practice location:
  • Phone: 706-270-8008
  • Fax: 706-270-8248
Mailing address:
  • Phone: 706-270-8008
  • Fax: 706-270-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-155-1591
License Number StateGA

VIII. Authorized Official

Name: GEORGE CARRAZANA
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-270-8008