Healthcare Provider Details

I. General information

NPI: 1619124849
Provider Name (Legal Business Name): HILLCREST DEVELOPMENT COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6082 GRAND LODGE AVE
PAPILLION NE
68133-3200
US

IV. Provider business mailing address

6082 GRAND LODGE AVE
PAPILLION NE
68133-3200
US

V. Phone/Fax

Practice location:
  • Phone: 402-885-7000
  • Fax: 402-885-7001
Mailing address:
  • Phone: 402-885-7000
  • Fax: 402-885-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0007
License Number StateNE

VIII. Authorized Official

Name: MS. JOLENE MATHISON ROBERTS
Title or Position: PRESIDENT
Credential:
Phone: 402-682-4800