Healthcare Provider Details

I. General information

NPI: 1336617836
Provider Name (Legal Business Name): HILLCREST SILVER RIDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20332 HACKBERRY DR
GRETNA NE
68028-4951
US

IV. Provider business mailing address

1902 HARLAN DR
BELLEVUE NE
68005-6602
US

V. Phone/Fax

Practice location:
  • Phone: 402-682-4800
  • Fax:
Mailing address:
  • Phone: 402-682-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KRIS MAPLES
Title or Position: IN-HOUSE COUNSEL/COMPLIANCE DIRECTO
Credential:
Phone: 402-682-4165