1417933656 NPI number — HILLTOP LODGE, INC.

Table of content: (NPI 1417933656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417933656 NPI number — HILLTOP LODGE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILLTOP LODGE, 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:
6
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:
1417933656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 467
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELOIT
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67420-0467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-738-3516
Provider Business Mailing Address Fax Number:
785-738-2332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 N. INDEPENDENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELOIT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67420-0467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-738-3516
Provider Business Practice Location Address Fax Number:
785-738-2332
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HEIDRICK
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
785-738-3516

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  N062001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100108300A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com