Provider Demographics
NPI:1407084387
Name:HIGHLAND RIVERS CENTER CSB
Entity type:Organization
Organization Name:HIGHLAND RIVERS CENTER CSB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-270-5000
Mailing Address - Street 1:1620 HICKORY ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2312
Mailing Address - Country:US
Mailing Address - Phone:706-270-5003
Mailing Address - Fax:706-370-7749
Practice Address - Street 1:1620 HICKORY ST
Practice Address - Street 2:SUITE 408
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2312
Practice Address - Country:US
Practice Address - Phone:706-270-5003
Practice Address - Fax:706-370-7749
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGHLAND RIVERS CENTER CSB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1447256243OtherORGANIZATIONAL NPI NUMBER
GA000603468NMedicaid