Provider Demographics
NPI:1023040425
Name:FLORIDA SENIOR HOUSING COUNCIL INC
Entity Type:Organization
Organization Name:FLORIDA SENIOR HOUSING COUNCIL INC
Other - Org Name:HIDDEN ACRES HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:MITTLEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-619-0866
Mailing Address - Street 1:925 N POINT PKWY
Mailing Address - Street 2:SUITE 440
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5210
Mailing Address - Country:US
Mailing Address - Phone:770-619-0866
Mailing Address - Fax:770-870-2892
Practice Address - Street 1:904 HIDDEN ACRES AVENUE
Practice Address - Street 2:
Practice Address - City:MT. PLEASENT
Practice Address - State:TN
Practice Address - Zip Code:38474-1039
Practice Address - Country:US
Practice Address - Phone:931-379-5502
Practice Address - Fax:931-379-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000181314000000X
GA651332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445374Medicaid
TN7440341Medicaid
TN0445374Medicaid
TN7440341Medicaid