Provider Demographics
NPI:1699755660
Name:HEIGHTS HEALTHCARE COMPANY LLC
Entity type:Organization
Organization Name:HEIGHTS HEALTHCARE COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-341-2777
Mailing Address - Street 1:1240 MARBELLA PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7906
Mailing Address - Country:US
Mailing Address - Phone:813-341-2777
Mailing Address - Fax:813-628-8275
Practice Address - Street 1:1440 COFFMAN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2726
Practice Address - Country:US
Practice Address - Phone:303-776-2814
Practice Address - Fax:303-776-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0615314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05652789Medicaid
CO05652789Medicaid