Basic Information
| Provider Information | |||||||||
| NPI: | 1801294293 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLAND RECOVERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 APPLEWOOD DRIVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062705033 | ||||||||
| FaxNumber: | 7703707749 | ||||||||
| Practice Location | |||||||||
| Address1: | 323 ROLAND ROAD | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062531112 | ||||||||
| FaxNumber: | 7062531120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2014 | ||||||||
| LastUpdateDate: | 12/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | DALLAS | ||||||||
| AuthorizedOfficialFirstName: | MELANIE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7062705000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HIGHLAND RIVERS COMMUNITY SERVICE BOARD | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.