MEDICARE: HILLCREST MANOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	ALLS3058	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013151059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLCREST MANOR

Provider Business Mailing Address
First Line	:	802 AUGUSTA RD
Second Line	:
City	:	ROME
State	:	ME
Zip	:	04963-3137
Country	:	US
Telephone Number	:	207-397-2131
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 AUGUSTA RD
Second Line	:
City	:	ROME
State	:	ME
Zip	:	04963-3137
Country	:	US
Telephone Number	:	207-397-2131
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JULIE M SMITH
Credential	:
Telephone Number	:	207-397-2131

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	04/21/2009

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1558745653 — MONICA JEAN NELSON SMITH
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1700329133 — THOMAS TARNAY MD
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Practice Location Address:

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Directions to “HILLCREST MANOR ” Practice Location

Language	Start Address	Practice Location

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