Provider Demographics
NPI:1033316955
Name:HIGHLAND PARK CENTER, INC.
Entity Type:Organization
Organization Name:HIGHLAND PARK CENTER, INC.
Other - Org Name:PARK TERRACE AT RADISSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-638-9207
Mailing Address - Street 1:2981 TOWN CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-8120
Mailing Address - Country:US
Mailing Address - Phone:315-638-9207
Mailing Address - Fax:315-638-8507
Practice Address - Street 1:2981 TOWN CENTER RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-8120
Practice Address - Country:US
Practice Address - Phone:315-638-9207
Practice Address - Fax:315-638-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY520-F-153310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02638255Medicaid