Provider Demographics
NPI:1184993156
Name:COLLEGE HILL-LTC LLC
Entity type:Organization
Organization Name:COLLEGE HILL-LTC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUSOTN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-522-2436
Mailing Address - Street 1:10945 STATE BRIDGE ROAD
Mailing Address - Street 2:SUITE 401-470
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022
Mailing Address - Country:US
Mailing Address - Phone:678-522-2436
Mailing Address - Fax:
Practice Address - Street 1:5005 EAST 21ST STREET NORTH
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208
Practice Address - Country:US
Practice Address - Phone:678-522-2436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility