Provider Demographics
NPI:1992162564
Name:HIGHLAND RIVERS
Entity type:Organization
Organization Name:HIGHLAND RIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECOVERY SERVICES SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LA TONYA
Authorized Official - Middle Name:RASHELL
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:706-428-4150
Mailing Address - Street 1:6 MATHIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165
Mailing Address - Country:US
Mailing Address - Phone:706-428-4150
Mailing Address - Fax:
Practice Address - Street 1:6 MATHIS DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1242
Practice Address - Country:US
Practice Address - Phone:706-428-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health