Provider Demographics
NPI:1194230656
Name:HILLCREST FAMILY SERVICES
Entity Type:Organization
Organization Name:HILLCREST FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFTENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-583-7357
Mailing Address - Street 1:2005 ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3042
Mailing Address - Country:US
Mailing Address - Phone:563-583-7357
Mailing Address - Fax:888-243-3455
Practice Address - Street 1:1160 SEIPPEL RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-9788
Practice Address - Country:US
Practice Address - Phone:563-557-4386
Practice Address - Fax:888-243-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health