Healthcare Provider Details

I. General information

NPI: 1861977019
Provider Name (Legal Business Name): HCC-HEALTHCARE PROPERTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 MARTIN LUTHER KING DR
CENTRALIA IL
62801-3002
US

IV. Provider business mailing address

5174 MCGINNIS FERRY RD STE 195
ALPHARETTA GA
30005-1792
US

V. Phone/Fax

Practice location:
  • Phone: 618-532-1308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: DOUG MITTLEIDER
Title or Position: PRESIDENT OF MANAGING MEMBER
Credential:
Phone: 470-282-3271