Provider Demographics
NPI:1295211506
Name:CHC HIGHLAND VILLAGE, LLC
Entity Type:Organization
Organization Name:CHC HIGHLAND VILLAGE, LLC
Other - Org Name:CONNECTED HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-964-3284
Mailing Address - Street 1:2150 JUSTIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7126
Mailing Address - Country:US
Mailing Address - Phone:469-312-3317
Mailing Address - Fax:469-312-3318
Practice Address - Street 1:2150 JUSTIN RD STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7126
Practice Address - Country:US
Practice Address - Phone:469-312-3317
Practice Address - Fax:469-312-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13510OtherLICENSE