Healthcare Provider Details

I. General information

NPI: 1023110400
Provider Name (Legal Business Name): HILLTOP NURSING HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 LAKE BARKLEY DR
KUTTAWA KY
42055-6124
US

IV. Provider business mailing address

1253 LAKE BARKLEY DR
KUTTAWA KY
42055-6124
US

V. Phone/Fax

Practice location:
  • Phone: 270-388-2291
  • Fax: 270-388-0948
Mailing address:
  • Phone: 270-388-2291
  • Fax: 270-388-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number100300
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number100300
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100300
License Number StateKY

VIII. Authorized Official

Name: LORI M GRAY
Title or Position: ACCOUNTS RECEIVABLE / BILLING
Credential:
Phone: 270-388-2291