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NPI Code Detail

MEDICARE: HILLSTONE HEALTHCARE OF BLOOMVILLE LLC

MEDICARE: HILLSTONE HEALTHCARE OF BLOOMVILLE 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
1314000000XSkilled Nursing FacilityOH

General Provider Information

NPI Number : 1104216449
Entity Type Code : Organization
Provider Name (Legal Business Name) : HILLSTONE HEALTHCARE OF BLOOMVILLE LLC
Provider Business Mailing Address
First Line : 2968 JERICHO PL
Second Line :
City : DELAWARE
State : OH
Zip : 43015-3175
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 22 CLINTON ST
Second Line :
City : BLOOMVILLE
State : OH
Zip : 44818-9399
Country : US
Telephone Number : 419-983-2021
Fax Number : 888-586-0347
Authorized Official
Title or Position : CEO
Name : PAUL BERGSTEN
Credential :
Telephone Number : 937-825-6622
Provider Enumeration Date : 01/26/2015
Last Update Date : 01/26/2015

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Directions to “HILLSTONE HEALTHCARE OF BLOOMVILLE LLC ” Practice Location

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