1932269925 NPI number — HILLTOP HEALTH SERVICES CORPORATION

Table of content: (NPI 1932269925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932269925 NPI number — HILLTOP HEALTH SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILLTOP HEALTH SERVICES CORPORATION
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:
HILLTOP COMMUNITY RESOURCES, INC.
Provider Other Organization Name Type Code:
3
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:
1932269925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1331 HERMOSA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81506-4099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-242-4400
Provider Business Mailing Address Fax Number:
970-243-4646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1105 COLORADO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81501-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-242-4400
Provider Business Practice Location Address Fax Number:
970-243-4646
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OBERLE
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR - FISCAL SERVICES
Authorized Official Telephone Number:
970-244-0402

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 86137743 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75750074 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90334566 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05702014 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15678822 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42572339 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51125544 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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