Provider Demographics
NPI:1770582330
Name:HILLCREST HOME
Entity type:Organization
Organization Name:HILLCREST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:309-944-2147
Mailing Address - Street 1:14688 ILLINOIS HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-8616
Mailing Address - Country:US
Mailing Address - Phone:309-944-2147
Mailing Address - Fax:309-944-8417
Practice Address - Street 1:14688 ILLINOIS HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-8616
Practice Address - Country:US
Practice Address - Phone:309-944-2147
Practice Address - Fax:309-944-8417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-17
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1099314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145949Medicare Oscar/Certification