Provider Demographics
NPI:1104838606
Name:HILLCREST HEALTHCARE, LLC
Entity Type:Organization
Organization Name:HILLCREST HEALTHCARE, LLC
Other - Org Name:HILLCREST HEALTHCARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:HIGHTOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-471-9797
Mailing Address - Street 1:111 PEMBERTON DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-1353
Mailing Address - Country:US
Mailing Address - Phone:615-792-9154
Mailing Address - Fax:615-792-7664
Practice Address - Street 1:111 PEMBERTON DR
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1353
Practice Address - Country:US
Practice Address - Phone:615-792-9154
Practice Address - Fax:615-792-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000318314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN445316Medicare UPIN