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General NPI Number Information
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NPI Number | 1861977019
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Entity Type | Organization
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Legal Business Name | HCC-HEALTHCARE PROPERTIES, LLC
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Dates
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Enumeration Date | 10/03/2018
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 1030 MARTIN LUTHER KING DR
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City | CENTRALIA
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State | IL
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Zip | 62801-3002
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Country | US
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Telephone | 618-532-1308
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Fax |
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Provider Business Mailing Address
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Address Line | 5174 MCGINNIS FERRY RD STE 195
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City | ALPHARETTA
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State | GA
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Zip | 30005-1792
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF MANAGING MEMBER
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Name | DOUG MITTLEIDER
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Credential |
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Telephone | 470-282-3271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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