Healthcare Provider Details

I. General information

NPI: 1184312100
Provider Name (Legal Business Name): HILLHAVEN SNF OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 POWDER MILL RD
ADELPHI MD
20783-1029
US

IV. Provider business mailing address

3210 POWDER MILL RD
ADELPHI MD
20783-1029
US

V. Phone/Fax

Practice location:
  • Phone: 240-542-6361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JEFFREY KAGAN
Title or Position: AUTHORIZED SIGNER
Credential:
Phone: 732-961-8432