Provider Demographics
NPI:1114020286
Name:HIGHLANDS HOME CARE, INC.
Entity type:Organization
Organization Name:HIGHLANDS HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SHAG
Authorized Official - Last Name:BRANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-889-9967
Mailing Address - Street 1:121 OAK RIDGE CT
Mailing Address - Street 2:P O BOX 757
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-8607
Mailing Address - Country:US
Mailing Address - Phone:606-889-9967
Mailing Address - Fax:606-886-7633
Practice Address - Street 1:121 OAK RIDGE CT
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-8607
Practice Address - Country:US
Practice Address - Phone:606-889-9967
Practice Address - Fax:606-886-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42050369251B00000X
KY150178251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000064779OtherANTHEM
KY42050369Medicaid
KY45001302Medicaid
KY34010363Medicaid
KY45001302Medicaid
KY42050369Medicaid