Provider Demographics
NPI:1508860495
Name:HICKORY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:HICKORY HEALTH CARE, INC.
Other - Org Name:HICKORY RIDGE NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-554-6619
Mailing Address - Street 1:25000 COUNTRY CLUB BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-5337
Mailing Address - Country:US
Mailing Address - Phone:440-614-0160
Mailing Address - Fax:
Practice Address - Street 1:721 HICKORY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-2213
Practice Address - Country:US
Practice Address - Phone:330-762-6486
Practice Address - Fax:330-762-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0525N314000000X
OH0525332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551457Medicaid
OH365134Medicare Oscar/Certification
OH365134Medicare ID - Type Unspecified