Healthcare Provider Details

I. General information

NPI: 1245347277
Provider Name (Legal Business Name): HIGHLANDER NURSING, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1748 HIGHLAND AVE
FALL RIVER MA
02720-4305
US

IV. Provider business mailing address

680 S 4TH ST # KH-2
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 508-730-1070
  • Fax: 508-730-2033
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0805
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier0923290
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier1874290
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerUNITED HEALTH CARE
# 3
Identifier43274357
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerSENIOR WHOLE HEALTH
# 4
Identifier2222572301
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name: MS. MARILYN A. WEAVER
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7563