Healthcare Provider Details

I. General information

NPI: 1396809620
Provider Name (Legal Business Name): HIGHLAND RIVERS CENTER, CSB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 WHITEHOUSE DR SUITE 200
DALTON GA
30720-8523
US

IV. Provider business mailing address

1620 HICKORY ST SUITE 406
DALTON GA
30720-2312
US

V. Phone/Fax

Practice location:
  • Phone: 706-270-5050
  • Fax: 706-270-5052
Mailing address:
  • Phone: 706-270-5002
  • Fax: 706-370-7749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateGA

VIII. Authorized Official

Name: FRANK AARON
Title or Position: CEO
Credential:
Phone: 706-270-5000