Basic Information
| Provider Information | |||||||||
| NPI: | 1578551768 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLAND PINES NURSING HOME, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 E WHALEY ST | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756016525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037575360 | ||||||||
| FaxNumber: | 9037538621 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 N 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756014739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037537661 | ||||||||
| FaxNumber: | 9037531056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 09/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | STEBBINS | ||||||||
| AuthorizedOfficialFirstName: | DICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT OF THE GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9037575360 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 111006 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 094510701 | 05 | TX | MEDICAID | 094510702 | 05 | TX | MEDICAID | HO6751337 | 05 | TX | MEDICAID | 000416003 | 05 | TX | MEDICAID |