Basic Information
| Provider Information | |||||||||
| NPI: | 1518965698 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATRIUM HILLCREST, LLC | ||||||||
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| OtherOrganizationName: | HILLCREST NURSING AND REHABILITATION COMMUNITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 HAKES DR | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | NORTON SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494415574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317996870 | ||||||||
| FaxNumber: | 2317990250 | ||||||||
| Practice Location | |||||||||
| Address1: | 695 MITZI ST | ||||||||
| Address2: | |||||||||
| City: | NORTH MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494453232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317441641 | ||||||||
| FaxNumber: | 2317449567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | LOCKHART | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF ACCOUNTING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6144160600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 61-4040 | MI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 60 2081901 | 05 | MI | MEDICAID | 09884 | 01 | MI | BCBS PROVIDER CODE | OTHER |