# BLUE RIVER HEALTHCARE INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Hillcrest Healthcare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528159266
- **Authorized official:** MRS. VETRESS MAE HOLT (ADMINISTRATOR)
- **Authorized official phone:** (580) 371-2636

## Contact information

- **Practice address:** 1105 E MAIN ST, TISHOMINGO, OK 73460-2401
- **Practice address phone:** (580) 371-2636
- **Practice address fax:** (580) 371-3890
- **Mailing address:** PO BOX 157, TISHOMINGO, OK 73460-0157
- **Mailing address phone:** (580) 371-2636
- **Mailing address fax:** (580) 371-3890

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH35013501 | OK | Yes |

## Other

- **Enumeration date:** 09/27/2006
- **Last updated:** 08/22/2020