Provider Demographics
NPI:1063173896
Name:HILLSIDE SENIOR LIVING
Entity type:Organization
Organization Name:HILLSIDE SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRIMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-463-7588
Mailing Address - Street 1:4162 ISABELLA CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2033
Mailing Address - Country:US
Mailing Address - Phone:951-463-7588
Mailing Address - Fax:
Practice Address - Street 1:4162 ISABELLA CIR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2033
Practice Address - Country:US
Practice Address - Phone:951-463-7588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility