Provider Demographics
NPI:1710048582
Name:HILLCREST CONVALESCENT CENTER INC
Entity Type:Organization
Organization Name:HILLCREST CONVALESCENT CENTER INC
Other - Org Name:HILLCREST CONVALESCENT CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHCY
Authorized Official - Prefix:
Authorized Official - First Name:HARRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
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:919-286-2065
Practice Address - Street 1:1417 W PETTIGREW ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4820
Practice Address - Country:US
Practice Address - Phone:919-286-7705
Practice Address - Fax:919-286-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC022653336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC325282Medicaid
2065765OtherPK