Provider Demographics
NPI:1124289038
Name:HIGHLAND MANOR, INC
Entity type:Organization
Organization Name:HIGHLAND MANOR, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOUVIELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-233-0804
Mailing Address - Street 1:1314 8TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073
Mailing Address - Country:US
Mailing Address - Phone:507-233-0800
Mailing Address - Fax:
Practice Address - Street 1:1314 8TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073
Practice Address - Country:US
Practice Address - Phone:507-233-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGHLAND MANOR INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-23
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN340073251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3A59OAOtherBCBS MN
MN915525200Medicaid
MN915525200Medicaid