Healthcare Provider Details

I. General information

NPI: 1942750518
Provider Name (Legal Business Name): HILLCREST HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14688 ILLINOIS HIGHWAY 82
GENESEO IL
61254-8616
US

IV. Provider business mailing address

14688 ILLINOIS HIGHWAY 82
GENESEO IL
61254-8616
US

V. Phone/Fax

Practice location:
  • Phone: 309-944-2147
  • Fax: 309-944-8417
Mailing address:
  • Phone: 309-944-2147
  • Fax: 309-944-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0001099
License Number StateIL

VIII. Authorized Official

Name: JULIE KAUFMAN
Title or Position: DIRECTOR OF ACCOUNTING
Credential:
Phone: 309-944-2147