Provider Demographics
NPI:1134165079
Name:HLTC, INC.
Entity type:Organization
Organization Name:HLTC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-226-4642
Mailing Address - Street 1:1115 PROFESSIONAL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2628
Mailing Address - Country:US
Mailing Address - Phone:706-226-4642
Mailing Address - Fax:706-226-9785
Practice Address - Street 1:1115 PROFESSIONAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2628
Practice Address - Country:US
Practice Address - Phone:706-226-4642
Practice Address - Fax:706-226-9785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HLTC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-155-1529314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
51001079 001OtherBCBS
GA000150279AMedicaid
51001079 001OtherBCBS