Provider Demographics
NPI:1104336874
Name:HIGHLINE ASSOCIATES, LLC
Entity type:Organization
Organization Name:HIGHLINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:RABER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-660-4383
Mailing Address - Street 1:2175A 37TH STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544
Mailing Address - Country:US
Mailing Address - Phone:505-695-1460
Mailing Address - Fax:
Practice Address - Street 1:1475 CENTRAL AVE STE 220
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4207
Practice Address - Country:US
Practice Address - Phone:505-660-4383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health