Provider Demographics
NPI:1942750518
Name:HILLCREST HOME
Entity Type:Organization
Organization Name:HILLCREST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-944-2147
Mailing Address - Street 1:14688 ILLINOIS HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-8616
Mailing Address - Country:US
Mailing Address - Phone:309-944-2147
Mailing Address - Fax:309-944-8417
Practice Address - Street 1:14688 ILLINOIS HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-8616
Practice Address - Country:US
Practice Address - Phone:309-944-2147
Practice Address - Fax:309-944-8417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001099332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies