Provider Demographics
NPI:1548246754
Name:HILLTOP NURSING HOME, INC.
Entity type:Organization
Organization Name:HILLTOP NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-388-2291
Mailing Address - Street 1:1253 LAKE BARKLEY DR
Mailing Address - Street 2:
Mailing Address - City:KUTTAWA
Mailing Address - State:KY
Mailing Address - Zip Code:42055-6124
Mailing Address - Country:US
Mailing Address - Phone:270-388-2291
Mailing Address - Fax:270-388-0948
Practice Address - Street 1:1253 LAKE BARKLEY DR
Practice Address - Street 2:
Practice Address - City:KUTTAWA
Practice Address - State:KY
Practice Address - Zip Code:42055-6124
Practice Address - Country:US
Practice Address - Phone:270-388-2291
Practice Address - Fax:270-388-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100300313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12300237Medicaid
KY12300237Medicaid