1922005230 NPI number — HILL NURSING HOME, INC.

Table of content: (NPI 1922005230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922005230 NPI number — HILL NURSING HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILL NURSING HOME, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922005230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 687
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IDABEL
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74745-0687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-286-5398
Provider Business Mailing Address Fax Number:
580-286-7924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 NW MARTIN LUTHER KING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDABEL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74745-4268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-286-5398
Provider Business Practice Location Address Fax Number:
580-286-7924
Provider Enumeration Date:
06/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
G.
Authorized Official Middle Name:
JOY
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
580-286-5398

Provider Taxonomy Codes

  • Taxonomy code: 310500000X , with the licence number:  NH4502-4502 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)