Provider Demographics
NPI:1922005230
Name:HILL NURSING HOME, INC.
Entity Type:Organization
Organization Name:HILL NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:G.
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-286-5398
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-0687
Mailing Address - Country:US
Mailing Address - Phone:580-286-5398
Mailing Address - Fax:580-286-7924
Practice Address - Street 1:808 NW MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-4268
Practice Address - Country:US
Practice Address - Phone:580-286-5398
Practice Address - Fax:580-286-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH4502-4502310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-5234Medicare ID - Type Unspecified