Healthcare Provider Details

I. General information

NPI: 1114020286
Provider Name (Legal Business Name): HIGHLANDS HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 OAK RIDGE CT
PRESTONSBURG KY
41653-8607
US

IV. Provider business mailing address

121 OAK RIDGE CT P O BOX 757
PRESTONSBURG KY
41653-8607
US

V. Phone/Fax

Practice location:
  • Phone: 606-889-9967
  • Fax: 606-886-7633
Mailing address:
  • Phone: 606-889-9967
  • Fax: 606-886-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number42050369
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number150178
License Number StateKY

VIII. Authorized Official

Name: MR. CHARLES SHAG BRANHAM
Title or Position: OPERATIONS ADMINISTRATOR
Credential:
Phone: 606-889-9967