Provider Demographics
NPI:1568494227
Name:HLTC, INC.
Entity Type:Organization
Organization Name:HLTC, INC.
Other - Org Name:WOOD DALE HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAXIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-226-1285
Mailing Address - Street 1:1102 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:706-226-1285
Mailing Address - Fax:706-226-6877
Practice Address - Street 1:1102 BURLEYSON RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720
Practice Address - Country:US
Practice Address - Phone:706-226-1285
Practice Address - Fax:706-226-6877
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HLTC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-06
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000143591AMedicaid
51001082 001OtherBCBS
115374Medicare Oscar/Certification