Organization
HCC-HEALTHCARE PROPERTIES, LLC
Active
Other names
Fireside House of Centralia
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG MITTLEIDER (PRESIDENT OF MANAGING MEMBER)
(470) 282-3271
Entity
Organization
Contact information
Practice address
1030 MARTIN LUTHER KING DR, CENTRALIA, IL 62801-3002
(618) 532-1308
Mailing address
5174 MCGINNIS FERRY RD STE 195, ALPHARETTA, GA 30005-1792
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58266671301
—
IL
Enumeration date
10/03/2018
Last updated
10/03/2018
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