Fireside-LTC, LLC

Skilled Nursing Facility · Centralia, IL

Organization Active NPI

NPI number 1346526134

Practice location

1030 Martin Luther King Dr
Centralia, IL 62801-3002
Phone
(678) 522-2436
Fax
(770) 663-4539

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NPI record

NPI
1346526134
Entity type
Organization (Type 2)
Enumeration date
October 25, 2011
Last updated
November 10, 2011
Organization subpart
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Skilled Nursing Facility Primary 314000000X — —

Mailing address

10945 State Bridge Rd
Suite 401-470
Alpharetta, GA 30022-8164
Phone
(678) 522-2436
Fax
(770) 663-4539

Authorized official

Name
Mr. Daren G Douston
Title
Member CFO
Phone
(678) 522-2436

Other names

  • Fireside House of Centralia

About Fireside-LTC, LLC

Fireside-LTC, LLC is a healthcare organization registered in the NPI registry with the primary taxonomy Skilled Nursing Facility (code 314000000X). The practice location is 1030 Martin Luther King Dr, Centralia, IL 62801-3002. The NPI number 1346526134 was assigned on October 25, 2011 and the record was last updated on November 10, 2011.

The authorized official for this organization is Mr. Daren G Douston, Member CFO.

Frequently asked questions

What is the NPI number of Fireside-LTC, LLC?

The NPI number is 1346526134.

What is the phone number of Fireside-LTC, LLC?

The phone number listed for the practice location is (678) 522-2436.

Where is Fireside-LTC, LLC located?

1030 Martin Luther King Dr, Centralia, IL 62801-3002.

What is the taxonomy code for Fireside-LTC, LLC?

The primary taxonomy code is 314000000X – Skilled Nursing Facility.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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