Provider Demographics
NPI:1346353307
Name:NORTON & NORTON LLC
Entity Type:Organization
Organization Name:NORTON & NORTON LLC
Other - Org Name:HILLCREST HAVEN CONVALESCENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-233-1411
Mailing Address - Street 1:1071 RENEE AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2508
Mailing Address - Country:US
Mailing Address - Phone:208-233-1411
Mailing Address - Fax:208-233-1515
Practice Address - Street 1:1071 RENEE AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2508
Practice Address - Country:US
Practice Address - Phone:208-233-1411
Practice Address - Fax:208-233-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID13-5018Medicare ID - Type UnspecifiedMEDICARE NUMBER