Provider Demographics
NPI:1215080635
Name:HILLSIDE ESTATE INC
Entity type:Organization
Organization Name:HILLSIDE ESTATE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-668-1659
Mailing Address - Street 1:2227 225TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52361-8503
Mailing Address - Country:US
Mailing Address - Phone:319-668-1659
Mailing Address - Fax:319-668-9863
Practice Address - Street 1:2227 225TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:IA
Practice Address - Zip Code:52361-8503
Practice Address - Country:US
Practice Address - Phone:319-668-1659
Practice Address - Fax:319-668-9863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-653311Z00000X, 311ZA0620X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Not Answered311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0258624Medicaid
IA0455170Medicaid
IA0895219Medicaid