Provider Demographics
NPI:1114170719
Name:HIGHER HEIGHTS DEVELOPMENTAL CENTER, LLC
Entity Type:Organization
Organization Name:HIGHER HEIGHTS DEVELOPMENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-945-8362
Mailing Address - Street 1:102 STRATFORD PL
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-8530
Mailing Address - Country:US
Mailing Address - Phone:252-945-8362
Mailing Address - Fax:
Practice Address - Street 1:102 STRATFORD PL
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-8530
Practice Address - Country:US
Practice Address - Phone:252-945-8362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management