Healthcare Provider Details

I. General information

NPI: 1497706659
Provider Name (Legal Business Name): HIGHLAND HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 56TH ST SE
CHARLESTON WV
25304-2308
US

IV. Provider business mailing address

300 56TH ST SE
CHARLESTON WV
25304-2308
US

V. Phone/Fax

Practice location:
  • Phone: 304-926-1600
  • Fax: 304-926-1649
Mailing address:
  • Phone: 304-926-1600
  • Fax: 304-926-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number151
License Number StateWV

VIII. Authorized Official

Name: MR. JAMES H. DISSEN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 304-348-1401