Healthcare Provider Details

I. General information

NPI: 1720123706
Provider Name (Legal Business Name): HIGHFIELDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 CLINTON RD
JACKSON MI
49202-2005
US

IV. Provider business mailing address

5123 OLD PLANK RD
ONONDAGA MI
49264-9707
US

V. Phone/Fax

Practice location:
  • Phone: 517-783-4250
  • Fax: 517-783-4164
Mailing address:
  • Phone: 517-628-2287
  • Fax: 517-628-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY M MONROE
Title or Position: VICE PRESIDENT
Credential: MSW
Phone: 517-628-2287