Provider Demographics
NPI:1659901130
Name:HILLCREST CONVALESCENT CENTER, INC.
Entity Type:Organization
Organization Name:HILLCREST CONVALESCENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HEFFNER
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:919-286-7705
Mailing Address - Street 1:1417 W PETTIGREW ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4820
Mailing Address - Country:US
Mailing Address - Phone:919-286-7705
Mailing Address - Fax:919-286-3772
Practice Address - Street 1:4215 UNIVERSITY DR STE B2
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2550
Practice Address - Country:US
Practice Address - Phone:919-627-6700
Practice Address - Fax:919-627-6627
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILLCREST CONVALESCENT CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)