Provider Demographics
NPI:1659369502
Name:HERITAGE HILLS NURSING CENTER INC
Entity Type:Organization
Organization Name:HERITAGE HILLS NURSING CENTER INC
Other - Org Name:HERITAGE HILLS LIVING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:918-691-1051
Mailing Address - Street 1:411 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4363
Mailing Address - Country:US
Mailing Address - Phone:918-423-2920
Mailing Address - Fax:918-423-1203
Practice Address - Street 1:411 N WEST ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4363
Practice Address - Country:US
Practice Address - Phone:918-423-2920
Practice Address - Fax:918-423-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH6105313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100684990AMedicaid
OK000375317001OtherBLUE CROSS BLUE SHIELD
OK000375317001OtherBLUE CROSS BLUE SHIELD