1114020286 NPI number — HIGHLANDS HOME CARE, INC.

Table of content: (NPI 1114020286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114020286 NPI number — HIGHLANDS HOME CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLANDS HOME CARE, INC.
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:
6
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:
1114020286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 OAK RIDGE CT
Provider Second Line Business Mailing Address:
P O BOX 757
Provider Business Mailing Address City Name:
PRESTONSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41653-8607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-889-9967
Provider Business Mailing Address Fax Number:
606-886-7633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 OAK RIDGE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESTONSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41653-8607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-889-9967
Provider Business Practice Location Address Fax Number:
606-886-7633
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRANHAM
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
SHAG
Authorized Official Title or Position:
OPERATIONS ADMINISTRATOR
Authorized Official Telephone Number:
606-889-9967

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  42050369 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 150178 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000064779 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 42050369 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45001302 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34010363 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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