Healthcare Provider Details

I. General information

NPI: 1962514380
Provider Name (Legal Business Name): HILLCREST NURSING HOME OF CORBIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 AMERICAN GREETING CARD RD
CORBIN KY
40701-4811
US

IV. Provider business mailing address

PO BOX 556
CORBIN KY
40702-0556
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-8917
  • Fax: 606-528-0070
Mailing address:
  • Phone: 606-528-8917
  • Fax: 606-528-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100425
License Number StateKY

VIII. Authorized Official

Name: MR. TERRY EMANUEL FORCHT
Title or Position: CHAIRMAN
Credential:
Phone: 606-528-9600