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General NPI Number Information
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NPI Number | 1417933656
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Entity Type | Organization
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Legal Business Name | HILLTOP LODGE, INC.
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 815 N. INDEPENDENCE AVE
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City | BELOIT
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State | KS
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Zip | 67420-0467
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Country | US
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Telephone | 785-738-3516
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Fax | 785-738-2332
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Provider Business Mailing Address
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Address Line | P.O. BOX 467
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City | BELOIT
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State | KS
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Zip | 67420-0467
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Country | US
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Telephone | 785-738-3516
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Fax | 785-738-2332
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. BRADLEY JAY HEIDRICK
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Credential |
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Telephone | 785-738-3516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | N062001
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License Number State | KS
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