Provider Demographics
NPI:1417933656
Name:HILLTOP LODGE, INC.
Entity Type:Organization
Organization Name:HILLTOP LODGE, INC.
Other - Org Name:HILLTOP LODGE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:HEIDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-738-3516
Mailing Address - Street 1:P.O. BOX 467
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420-0467
Mailing Address - Country:US
Mailing Address - Phone:785-738-3516
Mailing Address - Fax:785-738-2332
Practice Address - Street 1:815 N. INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420-0467
Practice Address - Country:US
Practice Address - Phone:785-738-3516
Practice Address - Fax:785-738-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN062001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100108300AMedicaid
175348Medicare Oscar/Certification