Provider Demographics
NPI:1033180534
Name:HIGHLAND RIDGE REHAB CENTER LLC
Entity Type:Organization
Organization Name:HIGHLAND RIDGE REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:NEWMAN
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-694-7161
Mailing Address - Street 1:5872 HANKS AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-2833
Mailing Address - Country:US
Mailing Address - Phone:540-674-4193
Mailing Address - Fax:540-674-6734
Practice Address - Street 1:5872 HANKS AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-2833
Practice Address - Country:US
Practice Address - Phone:540-674-4193
Practice Address - Fax:540-674-6734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2588313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA495333Medicare ID - Type Unspecified