Basic Information
| Provider Information | |||||||||
| NPI: | 1700872587 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HILLCREST NURSING AND REHABILITATION LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762014137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403874388 | ||||||||
| FaxNumber: | 9403802410 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 E BROWN ST | ||||||||
| Address2: | |||||||||
| City: | WYLIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750984451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724423553 | ||||||||
| FaxNumber: | 9724421622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 10/28/2011 | ||||||||
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| AuthorizedOfficialLastName: | RICH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9403874388 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 118577 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 161775501 | 01 | TX | TMHP CROSS-OVER | OTHER | 001004879 | 05 | TX | MEDICAID |