1710018858 NPI number — HILLCREST ADULT CARE FACILITY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710018858 NPI number — HILLCREST ADULT CARE FACILITY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILLCREST ADULT CARE FACILITY, 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:
1710018858
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:
2270 OAKLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28043-6921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-245-9765
Provider Business Mailing Address Fax Number:
828-245-5962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2270 OAKLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28043-6921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-245-9765
Provider Business Practice Location Address Fax Number:
828-245-5962
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SEARCY
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
828-245-9765

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7804143 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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