1962514380 NPI number — HILLCREST NURSING HOME OF CORBIN, 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 1962514380 NPI number — HILLCREST NURSING HOME OF CORBIN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILLCREST NURSING HOME OF CORBIN, 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:
HILLCREST NURSING HOME
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:
1962514380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 556
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORBIN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40702-0556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-528-8917
Provider Business Mailing Address Fax Number:
606-528-0070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1245 AMERICAN GREETING CARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-4811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-8917
Provider Business Practice Location Address Fax Number:
606-528-0070
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FORCHT
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
EMANUEL
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
606-528-9600

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  100425 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000054707 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 12501391 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".