Provider Demographics
NPI:1265475164
Name:HILLVIEW NURSING HOME INC
Entity Type:Organization
Organization Name:HILLVIEW NURSING HOME INC
Other - Org Name:LEGRAND HEALTHCARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-281-0322
Mailing Address - Street 1:650 HOLT ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4061
Mailing Address - Country:US
Mailing Address - Phone:318-281-0322
Mailing Address - Fax:318-281-3770
Practice Address - Street 1:650 HOLT ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4061
Practice Address - Country:US
Practice Address - Phone:318-281-0322
Practice Address - Fax:318-281-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA221314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1512192Medicaid
LA195554Medicare ID - Type UnspecifiedPROVIDER NUMBER