Provider Demographics
NPI:1033295266
Name:HILLCREST CARE & REHAB LLC
Entity Type:Organization
Organization Name:HILLCREST CARE & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-887-3811
Mailing Address - Street 1:1421 WEST SECOND STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71857-3342
Mailing Address - Country:US
Mailing Address - Phone:870-887-3811
Mailing Address - Fax:870-887-6019
Practice Address - Street 1:1421 WEST SECOND STREET NORTH
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AR
Practice Address - Zip Code:71857-3342
Practice Address - Country:US
Practice Address - Phone:870-887-3811
Practice Address - Fax:870-887-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR692314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045306Medicare ID - Type Unspecified