MEDICARE: HILLCREST SENIOR LIVING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	340194	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9839HI	OTHER		BCBS MN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073788311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLCREST SENIOR LIVING

Provider Business Mailing Address
First Line	:	311 BROADWAY AVE NE
Second Line	:
City	:	RED LAKE FALLS
State	:	MN
Zip	:	56750
Country	:	US
Telephone Number	:	218-253-2157
Fax Number	:	218-253-4676

Provider Business Practice Location Address
First Line	:	311 BROADWAY AVE NE
Second Line	:
City	:	RED LAKE FALLS
State	:	MN
Zip	:	56750
Country	:	US
Telephone Number	:	218-253-2157
Fax Number	:	218-253-4676

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANGELA MALONE
Credential	:
Telephone Number	:	218-253-2157

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	01/15/2009

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Directions to “HILLCREST SENIOR LIVING ” Practice Location

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