Healthcare Provider Details

I. General information

NPI: 1710048582
Provider Name (Legal Business Name): HILLCREST CONVALESCENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 W PETTIGREW ST
DURHAM NC
27705-4820
US

IV. Provider business mailing address

1417 W PETTIGREW ST
DURHAM NC
27705-4820
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-7705
  • Fax: 919-286-2065
Mailing address:
  • Phone: 919-286-7705
  • Fax: 919-286-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number02265
License Number StateNC

VIII. Authorized Official

Name: HARRIS HOLLINGSWORTH
Title or Position: DIR OF PHCY
Credential: RPH
Phone: 919-286-7705