Provider Demographics
NPI:1962514380
Name:HILLCREST NURSING HOME OF CORBIN, INC.
Entity type:Organization
Organization Name:HILLCREST NURSING HOME OF CORBIN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:FORCHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-528-9600
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-0556
Mailing Address - Country:US
Mailing Address - Phone:606-528-8917
Mailing Address - Fax:606-528-0070
Practice Address - Street 1:1245 AMERICAN GREETING CARD RD
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4811
Practice Address - Country:US
Practice Address - Phone:606-528-8917
Practice Address - Fax:606-528-0070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CORBIN LONG TERM CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100425314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054707OtherANTHEM BCBS
KY12501391Medicaid
KY185125Medicare Oscar/Certification