Provider Demographics
NPI:1912012436
Name:HILLCREST HOME, INC.
Entity Type:Organization
Organization Name:HILLCREST HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUNEVER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEYING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:563-578-8591
Mailing Address - Street 1:915 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IA
Mailing Address - Zip Code:50674-1271
Mailing Address - Country:US
Mailing Address - Phone:563-578-8591
Mailing Address - Fax:563-578-8091
Practice Address - Street 1:915 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674-1271
Practice Address - Country:US
Practice Address - Phone:563-578-8591
Practice Address - Fax:563-578-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16E043314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0801902Medicaid
IA65502OtherBCBS PROVIDER #
IA165502Medicare Oscar/Certification