Provider Demographics
NPI:1598725939
Name:MISSION INTERESTS COMMITTEE INC.
Entity Type:Organization
Organization Name:MISSION INTERESTS COMMITTEE INC.
Other - Org Name:HILLCREST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:870-741-5001
Mailing Address - Street 1:1111 MAPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 MAPLEWOOD RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3005
Practice Address - Country:US
Practice Address - Phone:870-741-5001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR206314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184820311Medicaid
AR045441Medicare Oscar/Certification