Provider Demographics
NPI:1023219284
Name:HILLSIDE, INC.
Entity Type:Organization
Organization Name:HILLSIDE, INC.
Other - Org Name:HILLSIDE HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:PAULETTE
Authorized Official - Last Name:STOKER
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:404-875-4551
Mailing Address - Street 1:690 COURTENAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306
Mailing Address - Country:US
Mailing Address - Phone:404-875-4551
Mailing Address - Fax:404-892-2201
Practice Address - Street 1:690 COURTENAY DRIVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306
Practice Address - Country:US
Practice Address - Phone:404-875-4551
Practice Address - Fax:404-892-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-411323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility