MEDICARE: HIGHLAND RIVERS CENTER, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1447256243	OTHER	GA	ORGANIZATION MASTER NPI

General Provider Information

NPI Number	:	1093879827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND RIVERS CENTER, CSB

Provider Business Mailing Address
First Line	:	1401 BURLEYSON DR
Second Line	:	SUITE 1
City	:	DALTON
State	:	GA
Zip	:	30720-2522
Country	:	US
Telephone Number	:	706-270-5002
Fax Number	:	706-370-7749

Provider Business Practice Location Address
First Line	:	18090 HIGHWAY 515 N
Second Line	:
City	:	ELLIJAY
State	:	GA
Zip	:	30536-1331
Country	:	US
Telephone Number	:	706-276-2024
Fax Number	:	706-276-1502

Authorized Official
Title or Position	:	CEO
Name	:	KLAY WEAVER
Credential	:
Telephone Number	:	706-270-5000

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	08/22/2020

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Directions to “HIGHLAND RIVERS CENTER, CSB ” Practice Location

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