Basic Information
| Provider Information | |||||||||
| NPI: | 1396702445 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLAND HEALTH PROVIDERS CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1487 NORTH HIGH ST. SUITE 102, ATTN: CFO | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451337736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378406617 | ||||||||
| FaxNumber: | 9373936278 | ||||||||
| Practice Location | |||||||||
| Address1: | 1487 N HIGH ST | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451338496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373933406 | ||||||||
| FaxNumber: | 9373930511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 03/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | WARIX | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9373935753 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 2284193 | 05 | OH | MEDICAID |