Provider Demographics
NPI:1285622324
Name:HIGHLAND HEALTHCARE AND REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:HIGHLAND HEALTHCARE AND REHABILITATION CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:402 S. AVENUE ST.
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:KS
Mailing Address - Zip Code:66035-4162
Mailing Address - Country:US
Mailing Address - Phone:785-442-3217
Mailing Address - Fax:785-442-3733
Practice Address - Street 1:402 S. AVENUE ST.
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:KS
Practice Address - Zip Code:66035-4162
Practice Address - Country:US
Practice Address - Phone:785-442-3217
Practice Address - Fax:785-442-3733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-12
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN220002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200304730AMedicaid
KS175412Medicare Oscar/Certification