Healthcare Provider Details

I. General information

NPI: 1659901130
Provider Name (Legal Business Name): HILLCREST CONVALESCENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 UNIVERSITY DR STE B2
DURHAM NC
27707-2550
US

IV. Provider business mailing address

1417 W PETTIGREW ST
DURHAM NC
27705-4820
US

V. Phone/Fax

Practice location:
  • Phone: 919-627-6700
  • Fax: 919-627-6627
Mailing address:
  • Phone: 919-286-7705
  • Fax: 919-286-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM HEFFNER HOOVER II
Title or Position: CFO
Credential:
Phone: 919-286-7705