Provider Demographics
NPI:1619030293
Name:HILLANDALE NURSING CARE, LTD.
Entity Type:Organization
Organization Name:HILLANDALE NURSING CARE, LTD.
Other - Org Name:BIRCHWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:G
Authorized Official - Last Name:ONTKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-326-0005
Mailing Address - Street 1:8073 TYLERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2589
Mailing Address - Country:US
Mailing Address - Phone:513-777-1400
Mailing Address - Fax:513-777-4249
Practice Address - Street 1:4070 HAMILTON MASON RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-5414
Practice Address - Country:US
Practice Address - Phone:513-777-1400
Practice Address - Fax:513-777-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5092314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2439356Medicaid
OH366159Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER