Healthcare Provider Details

I. General information

NPI: 1023040425
Provider Name (Legal Business Name): FLORIDA SENIOR HOUSING COUNCIL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 HIDDEN ACRES AVENUE
MT. PLEASENT TN
38474-1039
US

IV. Provider business mailing address

925 N POINT PKWY SUITE 440
ALPHARETTA GA
30005-5210
US

V. Phone/Fax

Practice location:
  • Phone: 931-379-5502
  • Fax: 931-379-5504
Mailing address:
  • Phone: 770-619-0866
  • Fax: 770-870-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000181
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number651
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number651
License Number StateGA

VIII. Authorized Official

Name: DOUGLAS K MITTLEIDER
Title or Position: PRESIDENT
Credential:
Phone: 770-619-0866