Provider Demographics
NPI:1639556806
Name:HILLCREST RALEIGH AT CRABTREE, LLC
Entity type:Organization
Organization Name:HILLCREST RALEIGH AT CRABTREE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HEFFNER
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:II
Authorized Official - Credentials:
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:919-286-3772
Practice Address - Street 1:3830 BLUE RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4319
Practice Address - Country:US
Practice Address - Phone:919-781-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILLCREST CONVALESCENT CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-27
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0428314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405555Medicaid
NC345555Medicare Oscar/Certification