Provider Demographics
NPI:1326043985
Name:MLB HILLTOP HEALTH FACILITIES INC.
Entity Type:Organization
Organization Name:MLB HILLTOP HEALTH FACILITIES INC.
Other - Org Name:MOUNTAIN CREST NURSING AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-635-9500
Mailing Address - Street 1:2586 LAFEUILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-8209
Mailing Address - Country:US
Mailing Address - Phone:513-662-0089
Mailing Address - Fax:513-662-0089
Practice Address - Street 1:2586 LAFEUILLE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-8209
Practice Address - Country:US
Practice Address - Phone:513-662-0089
Practice Address - Fax:513-662-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH520002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2244959Medicaid
OH365005Medicare Oscar/Certification