Provider Demographics
NPI:1912210501
Name:HILL'S HOUSE
Entity Type:Organization
Organization Name:HILL'S HOUSE
Other - Org Name:HILL'S HOUSE PERSONAL CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:QUANTRELL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HANNAH
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:706-871-8119
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:3649 HWY 88
Mailing Address - City:BLYTHE
Mailing Address - State:GA
Mailing Address - Zip Code:30805-0062
Mailing Address - Country:US
Mailing Address - Phone:706-751-0043
Mailing Address - Fax:706-733-9853
Practice Address - Street 1:3649 HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:GA
Practice Address - Zip Code:30805-3620
Practice Address - Country:US
Practice Address - Phone:706-751-0043
Practice Address - Fax:706-733-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121-02-072-9310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility