1396702445 NPI number — HIGHLAND HEALTH PROVIDERS CORP

Table of content: (NPI 1396702445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396702445 NPI number — HIGHLAND HEALTH PROVIDERS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLAND HEALTH PROVIDERS CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396702445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1487 NORTH HIGH ST. SUITE 102, ATTN: CFO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45133-7736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-840-6617
Provider Business Mailing Address Fax Number:
937-393-6278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1487 N HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45133-8496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-393-3406
Provider Business Practice Location Address Fax Number:
937-393-0511
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARIX
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
937-393-5753

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2284193 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com