Healthcare Provider Details

I. General information

NPI: 1871578633
Provider Name (Legal Business Name): HILLTOP MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 S. VALLEY
CUNNINGHAM KS
67035-0008
US

IV. Provider business mailing address

PO BOX 8 403 S. VALLEY
CUNNINGHAM KS
67035-0008
US

V. Phone/Fax

Practice location:
  • Phone: 620-298-2781
  • Fax: 620-298-3437
Mailing address:
  • Phone: 620-298-2781
  • Fax: 620-298-3437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberN-048-001
License Number StateKS

VIII. Authorized Official

Name: MARY KATHLENE 'KATHY' HAMILTON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 620-298-2781