MEDICARE: HILLCREST CARE CENTER

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	2004-NCF-478	UT

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	:	1902804222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLCREST CARE CENTER

Provider Business Mailing Address
First Line	:	PO BOX 470
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84091-0470
Country	:	US
Telephone Number	:	801-566-4191
Fax Number	:	801-566-1548

Provider Business Practice Location Address
First Line	:	348 E 8000 S
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-0107
Country	:	US
Telephone Number	:	801-566-4191
Fax Number	:	801-566-1548

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BRIAN HEUGLY
Credential	:	RN
Telephone Number	:	801-566-4191

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/30/2008

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Directions to “HILLCREST CARE CENTER ” Practice Location

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