Healthcare Provider Details

I. General information

NPI: 1538589312
Provider Name (Legal Business Name): HILLCREST HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CAPITOL ST SUITE 500
CHARLESTON WV
25301-2221
US

IV. Provider business mailing address

PO BOX 532
CHARLESTON WV
25322-0532
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-1623
  • Fax: 304-344-5853
Mailing address:
  • Phone: 304-344-1623
  • Fax: 304-344-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number135
License Number StateWV

VIII. Authorized Official

Name: TAMMY JO PAINTER
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 304-344-1623