Provider Demographics
NPI:1558806810
Name:HILLCREST OF WAYZATTA OPERATIONS LLC
Entity Type:Organization
Organization Name:HILLCREST OF WAYZATTA OPERATIONS LLC
Other - Org Name:HILLCREST OF WAYZATA REHABILITATION AND HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EPHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAHASKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-772-3668
Mailing Address - Street 1:15409 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1402
Mailing Address - Country:US
Mailing Address - Phone:952-473-5466
Mailing Address - Fax:852-473-6842
Practice Address - Street 1:15409 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1402
Practice Address - Country:US
Practice Address - Phone:952-473-5466
Practice Address - Fax:852-473-6842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility