Hillcrest Shadow Lake, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

HILLCREST SHADOW LAKE, LLC

Doing business as

Hillcrest Shadow Lake

Practice address

1507 E Gold Coast Rd
Papillion, NE 68046-4722

Phone

(402) 339-6010

NPI assigned

Nov 22, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jolene L Mathison Roberts

Title

President

Phone

(402) 682-4800

Specialties & licenses 1

Addresses

Other names 1

• Hillcrest Shadow Lake Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Anthony Hatcher, D.O.

  • Family Medicine Physician
  • Bellevue, NE
  • NPI 1952451957
  NPD (past)
• Joseph S Miller, M.D.

  • Family Medicine Physician
  • Bellevue, NE
  • NPI 1063456465
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637539200000",
    "number": "1245997436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1902 HARLAN DR STE A",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "680056609",
            "telephone_number": "402-682-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 E GOLD COAST RD",
            "city": "PAPILLION",
            "state": "NE",
            "postal_code": "680464722",
            "telephone_number": "402-339-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLCREST SHADOW LAKE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-22",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-05",
        "status": "A",
        "authorized_official_last_name": "MATHISON ROBERTS",
        "authorized_official_first_name": "JOLENE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-682-4800"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hillcrest Shadow Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chelsea Hill
• Elizabeth Anne Hill
• Shi'Randi A Hill
• Hillcrest Development Company LLC (Hillcrest Country Estates)
• Hillcrest Shadow Lake LLC
• Sophia Hiller
• Micala Hinkle
• Alyssa Ann Hinze
• Karly Hippe
• Kimberly T Hirsch

• Skilled Nursing Facility in Papillion, NE
• Providers in Papillion, NE by specialty
• Skilled Nursing Facility in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.