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General NPI Number Information
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NPI Number | 1093878464
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Entity Type | Organization
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Legal Business Name | HIGHLAND RIVERS CSB
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 900 SHUGART RD SUITE C
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City | DALTON
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State | GA
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Zip | 30720-2467
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Country | US
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Telephone | 706-270-5047
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Fax | 706-270-5055
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Provider Business Mailing Address
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Address Line | 1401 APPLEWOOD DIRVE SUITE 1
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City | DALTON
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State | GA
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Zip | 30720-2699
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Country | US
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Telephone | 706-270-5002
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Fax | 706-370-7749
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Authorized Official
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Title or Position | CEO
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Name | MR. JASON BEARDEN
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Credential |
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Telephone | 706-270-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | GA
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