Healthcare Provider Details

I. General information

NPI: 1992889786
Provider Name (Legal Business Name): HILLCREST EXTENDED CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 VALENTINE RD
PITTSFIELD MA
01201-3042
US

IV. Provider business mailing address

169 VALENTINE RD
PITTSFIELD MA
01201-3042
US

V. Phone/Fax

Practice location:
  • Phone: 413-445-2300
  • Fax: 413-445-2306
Mailing address:
  • Phone: 413-445-2300
  • Fax: 413-445-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0989
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number0989
License Number StateMA

VIII. Authorized Official

Name: MS. AMALE NEARY
Title or Position: ASSOCIATE V.P. OF FINANCE
Credential:
Phone: 413-447-2416