# HILLCREST CONVALESCENT CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336142470
- **Authorized official:** MR. THOMAS TED SMITH NHA (ADMINISTRATOR)
- **Authorized official phone:** (919) 286-7705

## Contact information

- **Practice address:** 1417 W PETTIGREW ST, DURHAM, NC 27705-4820
- **Practice address phone:** (919) 286-7705
- **Practice address fax:** (919) 286-3772
- **Mailing address:** 1417 W PETTIGREW ST, DURHAM, NC 27705-4820
- **Mailing address phone:** (919) 286-7705
- **Mailing address fax:** (919) 286-3772

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | NH0038 | NC | — |
| 314000000X | Skilled Nursing Facility | NH0038 | NC | Yes |

## Other

- **Enumeration date:** 05/23/2005
- **Last updated:** 01/23/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3405001 | SKILLED MEDICAID | NC |
| 05 | — | 3496052 | — | NC |