Provider Demographics
NPI:1336142470
Name:HILLCREST CONVALESCENT CENTER, INC.
Entity Type:Organization
Organization Name:HILLCREST CONVALESCENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:TED
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:919-286-7705
Mailing Address - Street 1:1417 W PETTIGREW ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4820
Mailing Address - Country:US
Mailing Address - Phone:919-286-7705
Mailing Address - Fax:919-286-3772
Practice Address - Street 1:1417 W PETTIGREW ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4820
Practice Address - Country:US
Practice Address - Phone:919-286-7705
Practice Address - Fax:919-286-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0038261QR0400X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3496052Medicaid
NC3405001OtherSKILLED MEDICAID
NC3496052Medicaid