MEDICARE: HIGHLAND RIVERS CSB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		GA
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1447256243	OTHER	GA	ORGANIZATION MASTER NPI

General Provider Information

NPI Number	:	1043373467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND RIVERS CSB

Provider Business Mailing Address
First Line	:	1401 APPLEWOOD DRIVE
Second Line	:	SUITE 1
City	:	DALTON
State	:	GA
Zip	:	30720-2699
Country	:	US
Telephone Number	:	706-270-5002
Fax Number	:	706-370-7749

Provider Business Practice Location Address
First Line	:	191 LAMAR HALEY DR
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-8019
Country	:	US
Telephone Number	:	770-704-1600
Fax Number	:	770-704-1610

Authorized Official
Title or Position	:	CEO
Name	:	MR. JASON BEARDEN
Credential	:
Telephone Number	:	706-270-5000

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	09/20/2011

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Directions to “HIGHLAND RIVERS CSB ” Practice Location

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