MEDICARE: BLACKHAWK HOLDINGS OPERATIONS NT-HCI LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1093249021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACKHAWK HOLDINGS OPERATIONS NT-HCI LLC

Provider Business Mailing Address
First Line	:	399 PARK AVE
Second Line	:	FLOOR 18
City	:	NEW YORK
State	:	NY
Zip	:	10022-4614
Country	:	US
Telephone Number	:	212-547-2659
Fax Number	:

Provider Business Practice Location Address
First Line	:	22550 S FRANKLIN ST
Second Line	:
City	:	SPRING HILL
State	:	KS
Zip	:	66083-8763
Country	:	US
Telephone Number	:	913-592-5101
Fax Number	:

Authorized Official
Title or Position	:	GENERAL COUNSEL AND SECRETARY
Name	:	MS. ANN B HARRINGTON
Credential	:
Telephone Number	:	212-547-2659

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	04/17/2017

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