Healthcare Provider Details

I. General information

NPI: 1568494227
Provider Name (Legal Business Name): HLTC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 BURLEYSON RD
DALTON GA
30720
US

IV. Provider business mailing address

1102 BURLEYSON RD
DALTON GA
30720-3016
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-1285
  • Fax: 706-226-6877
Mailing address:
  • Phone: 706-226-1285
  • Fax: 706-226-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MAXIC BURGER
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-226-1285