Healthcare Provider Details

I. General information

NPI: 1134115454
Provider Name (Legal Business Name): HILLCREST CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 CLARKE ST
DE SOTO MO
63020-2706
US

IV. Provider business mailing address

1108 CLARKE ST
DE SOTO MO
63020-2706
US

V. Phone/Fax

Practice location:
  • Phone: 636-586-3022
  • Fax: 636-586-1440
Mailing address:
  • Phone: 636-586-3022
  • Fax: 636-586-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031445
License Number StateMO

VIII. Authorized Official

Name: CARLA HEDRICK
Title or Position: CFO
Credential: CFO
Phone: 573-481-9625