MEDICARE: HIGHLAND RIVERS COMMUNITY SERVICE BOARD

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

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

General Provider Information

NPI Number	:	1801148879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND RIVERS COMMUNITY SERVICE BOARD

Provider Business Mailing Address
First Line	:	1401 APPLEWOOD DR STE 1
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-2699
Country	:	US
Telephone Number	:	706-270-5033
Fax Number	:	706-370-7749

Provider Business Practice Location Address
First Line	:	51 NEW LIBERTY TRAIL
Second Line	:
City	:	ELLIJAY
State	:	GA
Zip	:	30536-4755
Country	:	US
Telephone Number	:	706-270-5033
Fax Number	:	706-370-7749

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	ROBIN WHITLOW
Credential	:
Telephone Number	:	706-270-5033

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	10/15/2012

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Directions to “HIGHLAND RIVERS COMMUNITY SERVICE BOARD ” Practice Location

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