Provider Demographics
NPI:1679792964
Name:HILLSIDE CARE CENTER, INC.
Entity type:Organization
Organization Name:HILLSIDE CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:LENAE
Authorized Official - Last Name:LIONBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:573-221-1439
Mailing Address - Street 1:321 N SECTION ST
Mailing Address - Street 2:P.O. BOX 308
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3460
Mailing Address - Country:US
Mailing Address - Phone:573-221-1439
Mailing Address - Fax:573-406-1232
Practice Address - Street 1:321 N SECTION ST
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3460
Practice Address - Country:US
Practice Address - Phone:573-221-1439
Practice Address - Fax:573-406-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032545310400000X
MO24969410310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility