Healthcare Provider Details

I. General information

NPI: 1427072016
Provider Name (Legal Business Name): HILLHAVEN - MSC PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 19TH AVE
SAN FRANCISCO CA
94116-1253
US

IV. Provider business mailing address

680 S. 4TH STREET
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 415-661-8787
  • Fax: 415-566-7154
Mailing address:
  • Phone: 502-596-7563
  • Fax: 502-596-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number220000024
License Number StateCA

VIII. Authorized Official

Name: MS. MARILYN A. WEAVER
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7563