Provider Demographics
NPI:1093879827
Name:HIGHLAND RIVERS CENTER, CSB
Entity Type:Organization
Organization Name:HIGHLAND RIVERS CENTER, CSB
Other - Org Name:HIGHLAND RIVERS GILMER C&A SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-270-5000
Mailing Address - Street 1:1401 BURLEYSON DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2522
Mailing Address - Country:US
Mailing Address - Phone:706-270-5002
Mailing Address - Fax:706-370-7749
Practice Address - Street 1:18090 HIGHWAY 515 N
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30536-1331
Practice Address - Country:US
Practice Address - Phone:706-276-2024
Practice Address - Fax:706-276-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1447256243OtherORGANIZATION MASTER NPI
GA1447256243OtherORGANIZATION MASTER NPI