Basic Information
| Provider Information | |||||||||
| NPI: | 1548246754 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HILLTOP NURSING HOME, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1253 LAKE BARKLEY DR | ||||||||
| Address2: | |||||||||
| City: | KUTTAWA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420556124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703882291 | ||||||||
| FaxNumber: | 2703880948 | ||||||||
| Practice Location | |||||||||
| Address1: | 1253 LAKE BARKLEY DR | ||||||||
| Address2: | |||||||||
| City: | KUTTAWA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420556124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703882291 | ||||||||
| FaxNumber: | 2703880948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GRAY | ||||||||
| AuthorizedOfficialFirstName: | ROSE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2703882291 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 100300 | KY | X | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | 100300 | KY | X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 12300237 | 05 | KY | MEDICAID |