Healthcare Provider Details

I. General information

NPI: 1437127024
Provider Name (Legal Business Name): HILLCREST HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 HILLCREST DR
EMPORIA KS
66801-6093
US

IV. Provider business mailing address

2107 INDUSTRIAL DR
MCPHERSON KS
67460-8128
US

V. Phone/Fax

Practice location:
  • Phone: 620-342-8601
  • Fax: 620-342-8629
Mailing address:
  • Phone: 620-241-6693
  • Fax: 620-241-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License NumberN-056-008
License Number StateKS

VIII. Authorized Official

Name: MR. COLIN MCKENNEY
Title or Position: CEO
Credential:
Phone: 620-241-6693