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General NPI Number Information
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NPI Number | 1962435149
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Entity Type | Organization
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Legal Business Name | SALEM HOUSING CORPORATION
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 315 W GIBSON ST
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City | JASPER
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State | TX
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Zip | 75951-4903
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Country | US
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Telephone | 409-384-5768
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Fax | 409-383-1940
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Provider Business Mailing Address
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Address Line | 5895 WINDWARD PKWY SUITE 200
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City | ALPHARETTA
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State | GA
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Zip | 30005-5203
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Country | US
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Telephone | 770-619-0866
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Fax | 770-870-2892
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Authorized Official
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Title or Position | PRESIDENT OF MGMT CO
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Name | DOUGLAS K. MITTLEIDER
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Credential |
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Telephone | 770-619-0866
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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 | 116446
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License Number State | TX
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