Healthcare Provider Details

I. General information

NPI: 1477804524
Provider Name (Legal Business Name): HIGHLAND RIVERS COMMUNITY SERVICE BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 ADAMS CHAPEL RD SW
CARTERSVILLE GA
30120-6001
US

IV. Provider business mailing address

1401 APPLEWOOD DR STE 1
DALTON GA
30720-2699
US

V. Phone/Fax

Practice location:
  • Phone: 706-270-5033
  • Fax: 706-370-7749
Mailing address:
  • Phone: 706-270-5033
  • Fax: 706-370-7749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000936559GX
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: ROBIN WHITLOW
Title or Position: BILLING MANAGER
Credential:
Phone: 706-270-5033