Provider Demographics
NPI:1518115062
Name:HILLCREST HEALTHCARE LLC
Entity Type:Organization
Organization Name:HILLCREST HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:HIGHTOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-471-9797
Mailing Address - Street 1:111 PEMBERTON DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-1353
Mailing Address - Country:US
Mailing Address - Phone:615-792-9154
Mailing Address - Fax:615-792-7664
Practice Address - Street 1:111 PEMBERTON DR
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1353
Practice Address - Country:US
Practice Address - Phone:615-792-9154
Practice Address - Fax:615-792-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN318313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445316OtherMEDICAID SKILLED
TN7440577Medicaid
TN445316Medicare UPIN