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General NPI Number Information
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NPI Number | 1437451259
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Entity Type | Organization
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Legal Business Name | HI-LAND MOUNTAIN HOMES
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 27482 N. BAY ROAD.
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City | LAKE ARROWHEAD
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State | CA
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Zip | 92352
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Country | US
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Telephone | 909-338-1234
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1502
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City | LAKE ARROWHEAD
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State | CA
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Zip | 92352-1502
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Country | US
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Telephone | 909-338-1234
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KORY AVARELL
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Credential |
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Telephone | 909-338-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 360082AP
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License Number State | CA
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