Provider Demographics
NPI:1386998243
Name:HIGHER GROUND UNLIMITED
Entity type:Organization
Organization Name:HIGHER GROUND UNLIMITED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHENISE
Authorized Official - Middle Name:LYTRELLE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:321-947-0706
Mailing Address - Street 1:PO BOX 2967
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32721-2967
Mailing Address - Country:US
Mailing Address - Phone:321-947-0706
Mailing Address - Fax:
Practice Address - Street 1:118 1/2 N WOODLAND BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-4268
Practice Address - Country:US
Practice Address - Phone:386-734-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007901900Medicaid