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General NPI Number Information
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NPI Number | 1699886085
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Entity Type | Organization
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Legal Business Name | HIGHLAND HOUSE OF FAYETTEVILLE, INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/13/2012
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Provider Practice Location Address
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Address Line | 1700 PAMALEE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-2824
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Country | US
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Telephone | 910-488-2295
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Fax | 910-488-0087
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Provider Business Mailing Address
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Address Line | 1700 PAMALEE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-2824
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Country | US
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Telephone | 910-488-2295
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Fax | 910-488-0087
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Authorized Official
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Title or Position | CONTROLLER
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Name | EDWARD ELLER
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Credential |
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Telephone | 336-998-5001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH0117
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License Number State | NC
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