Basic Information
| Provider Information | |||||||||
| NPI: | 1659901130 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HILLCREST CONVALESCENT CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1417 W PETTIGREW ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277054820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192867705 | ||||||||
| FaxNumber: | 9192863772 | ||||||||
| Practice Location | |||||||||
| Address1: | 4215 UNIVERSITY DR STE B2 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277072550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196276700 | ||||||||
| FaxNumber: | 9196276627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2020 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOOVER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | HEFFNER | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9192867705 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HILLCREST CONVALESCENT CENTER, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0401X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.