MEDICARE: HIGHLINE ASSOCIATES, LLC

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		NM

General Provider Information

NPI Number	:	1104336874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLINE ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	2175A 37TH STREET
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544
Country	:	US
Telephone Number	:	505-695-1460
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 CENTRAL AVE STE 220
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-4207
Country	:	US
Telephone Number	:	505-660-4383
Fax Number	:

Authorized Official
Title or Position	:	TRUSTEE
Name	:	KRISTIN MARIA RABER
Credential	:	LISW
Telephone Number	:	505-660-4383

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	10/06/2017

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Directions to “HIGHLINE ASSOCIATES, LLC ” Practice Location

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