Provider Demographics
NPI:1134115454
Name:HILLCREST CARE CENTER, INC.
Entity Type:Organization
Organization Name:HILLCREST CARE CENTER, INC.
Other - Org Name:HILLCREST CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-392-0316
Mailing Address - Street 1:1108 CLARKE ST
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:MO
Mailing Address - Zip Code:63020-2706
Mailing Address - Country:US
Mailing Address - Phone:636-586-3022
Mailing Address - Fax:636-586-1440
Practice Address - Street 1:1108 CLARKE ST
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-2706
Practice Address - Country:US
Practice Address - Phone:636-586-3022
Practice Address - Fax:636-586-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031445314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108014408Medicaid
MO15745511OtherSTATE ID
MO265620Medicare Oscar/Certification