Healthcare Provider Details

I. General information

NPI: 1699886085
Provider Name (Legal Business Name): HIGHLAND HOUSE OF FAYETTEVILLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 PAMALEE DR
FAYETTEVILLE NC
28301-2824
US

IV. Provider business mailing address

1700 PAMALEE DR
FAYETTEVILLE NC
28301-2824
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-2295
  • Fax: 910-488-0087
Mailing address:
  • Phone: 910-488-2295
  • Fax: 910-488-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0117
License Number StateNC

VIII. Authorized Official

Name: EDWARD ELLER
Title or Position: CONTROLLER
Credential:
Phone: 336-998-5001