=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598736316
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NHCI OF HILLSBORO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2006
-----------------------------------------------------
Last Update Date | 11/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 CIRCLE DR
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76645-2670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-580-8500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 844829
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75284-4829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR VP, GROUP OPERATIONS
-----------------------------------------------------
Name | MICHAEL PORTACCI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-373-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 00383
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------