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General NPI Number Information
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NPI Number | 1942750518
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Entity Type | Organization
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Legal Business Name | HILLCREST HOME
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 14688 ILLINOIS HIGHWAY 82
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City | GENESEO
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State | IL
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Zip | 61254-8616
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Country | US
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Telephone | 309-944-2147
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Fax | 309-944-8417
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Provider Business Mailing Address
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Address Line | 14688 ILLINOIS HIGHWAY 82
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City | GENESEO
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State | IL
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Zip | 61254-8616
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Country | US
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Telephone | 309-944-2147
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Fax | 309-944-8417
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Authorized Official
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Title or Position | DIRECTOR OF ACCOUNTING
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Name | JULIE KAUFMAN
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Credential |
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Telephone | 309-944-2147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0001099
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License Number State | IL
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