Provider Demographics
NPI:1184653677
Name:HLTC, INC.
Entity Type:Organization
Organization Name:HLTC, INC.
Other - Org Name:RIDGEWOOD MANOR HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-226-1021
Mailing Address - Street 1:1110 BURLEYSON RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3016
Mailing Address - Country:US
Mailing Address - Phone:706-226-1021
Mailing Address - Fax:706-278-0619
Practice Address - Street 1:1110 BURLEYSON RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3016
Practice Address - Country:US
Practice Address - Phone:706-226-1021
Practice Address - Fax:706-278-0619
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HLTC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-30
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-155-1530314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000142744AMedicaid
51000924 001OtherBCBS
115341Medicare Oscar/Certification