Healthcare Provider Details

I. General information

NPI: 1346821220
Provider Name (Legal Business Name): HILLCREST CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HILLCREST AVE
WANAMINGO MN
55983-1464
US

IV. Provider business mailing address

400 HILLCREST AVE
WANAMINGO MN
55983-1464
US

V. Phone/Fax

Practice location:
  • Phone: 507-824-2091
  • Fax: 507-824-2249
Mailing address:
  • Phone: 507-824-2091
  • Fax: 507-824-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MALISSA STAHNKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 507-824-2091