MEDICARE: HIGHLAND RECOVERY 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1841832920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND RECOVERY LLC

Provider Business Mailing Address
First Line	:	PO BOX 191310
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-7310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9630 5TH ST
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2949
Country	:	US
Telephone Number	:	219-924-6953
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	HOWARD BROMBERG
Credential	:
Telephone Number	:	314-784-4402

Provider Enumeration Date	:	10/10/2019
Last Update Date	:	04/15/2021

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Directions to “HIGHLAND RECOVERY LLC ” Practice Location

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