Provider Demographics
NPI:1861859696
Name:HIDDEN ACRES HEALTHCARE, LLC
Entity Type:Organization
Organization Name:HIDDEN ACRES HEALTHCARE, LLC
Other - Org Name:MT. PLEASANT HEALTH & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:HART
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:423-584-6755
Mailing Address - Street 1:904 HIDDEN ACRES AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TN
Mailing Address - Zip Code:38474-1039
Mailing Address - Country:US
Mailing Address - Phone:931-379-5503
Mailing Address - Fax:
Practice Address - Street 1:904 HIDDEN ACRES AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TN
Practice Address - Zip Code:38474-1039
Practice Address - Country:US
Practice Address - Phone:931-379-5502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN181314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ028277Medicaid
TNQ028276Medicaid