MEDICARE: HILL CREEK ASSISTED LIVING LLC

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	310400000X	Assisted Living Facility	1104101	VA

General Provider Information

NPI Number	:	1629210711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILL CREEK ASSISTED LIVING LLC

Provider Business Mailing Address
First Line	:	305 HILL CREEK RD
Second Line	:
City	:	RICHLANDS
State	:	VA
Zip	:	24641-2016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 HILL CREEK RD
Second Line	:
City	:	RICHLANDS
State	:	VA
Zip	:	24641-2016
Country	:	US
Telephone Number	:	276-963-2828
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. CARRIE E. CRUTCHFIELD
Credential	:	LPN/ADMINISTRATOR
Telephone Number	:	276-963-2828

Provider Enumeration Date	:	04/03/2009
Last Update Date	:	04/03/2009

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