Provider Demographics
NPI:1033239660
Name:HILLTOP ADULT GROUP HOME INC.
Entity Type:Organization
Organization Name:HILLTOP ADULT GROUP HOME INC.
Other - Org Name:HILLTOP SUPPORTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:440-466-1131
Mailing Address - Street 1:7726 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-3031
Mailing Address - Country:US
Mailing Address - Phone:440-466-1131
Mailing Address - Fax:440-428-9778
Practice Address - Street 1:7726 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3031
Practice Address - Country:US
Practice Address - Phone:440-466-1131
Practice Address - Fax:440-428-9778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4300750251C00000X, 251E00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251E00000XAgenciesHome Health
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2030868Medicaid
OH4300750OtherODMRDD PROVIDER NUMBER