Provider Demographics
NPI:1144217696
Name:HILLCREST CARE CENTER
Entity Type:Organization
Organization Name:HILLCREST CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELSIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-256-3961
Mailing Address - Street 1:702 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:NE
Mailing Address - Zip Code:68745-1714
Mailing Address - Country:US
Mailing Address - Phone:402-256-3961
Mailing Address - Fax:402-256-9522
Practice Address - Street 1:702 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:NE
Practice Address - Zip Code:68745-1714
Practice Address - Country:US
Practice Address - Phone:402-256-3961
Practice Address - Fax:402-256-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE140301314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE227OtherASSISTED LIVING STATE LIC
NE124003OtherNURSING HOME STATE LIC.#
NE=========00Medicaid
NE0628510001Medicare NSC
NE28-5178Medicare ID - Type Unspecified