Provider Demographics
NPI:1891012043
Name:MOUNT PLEASANT HEALTHCARE LLC
Entity Type:Organization
Organization Name:MOUNT PLEASANT HEALTHCARE LLC
Other - Org Name:HIDDEN ACRES HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FACILITY ACCOUNTING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MATHENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-424-1839
Mailing Address - Street 1:7201 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2780
Mailing Address - Country:US
Mailing Address - Phone:423-308-1845
Mailing Address - Fax:423-308-1848
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:931-379-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445374Medicaid
TN7440341Medicaid
TN445374Medicare Oscar/Certification