Provider Demographics
NPI:1992889786
Name:HILLCREST EXTENDED CARE SERVICES, INC
Entity type:Organization
Organization Name:HILLCREST EXTENDED CARE SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE V.P. OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:AMALE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-447-2416
Mailing Address - Street 1:169 VALENTINE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-3042
Mailing Address - Country:US
Mailing Address - Phone:413-445-2300
Mailing Address - Fax:413-445-2306
Practice Address - Street 1:169 VALENTINE RD
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-3042
Practice Address - Country:US
Practice Address - Phone:413-445-2300
Practice Address - Fax:413-445-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0989314000000X, 3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0925683Medicaid
NY01660159Medicaid
NY01770525Medicaid
MA0931012Medicaid
MA0925683Medicaid
NY01660159Medicaid