Provider Demographics
NPI:1376541680
Name:HIGHLAND PARK CARE CENTER, LLC
Entity Type:Organization
Organization Name:HIGHLAND PARK CARE CENTER, LLC
Other - Org Name:HIGHLAND PARK CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:HENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-963-9150
Mailing Address - Street 1:209 SIGMA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2826
Mailing Address - Country:US
Mailing Address - Phone:412-963-9150
Mailing Address - Fax:412-963-6676
Practice Address - Street 1:745 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-2526
Practice Address - Country:US
Practice Address - Phone:412-362-6622
Practice Address - Fax:412-362-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA084902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018557400001Medicaid
PA247943OtherAETNA
PA000000122136OtherTHREE RIVERS PROVIDER NO.
PA000000122136OtherMED PLUS
PA1439OtherBLUE CROSS PROVIDER NO.
PA226361OtherADVANTRA
PA1518391OtherGATEWAY PROVIDER NUMBER
PA226361OtherHEALTH ASSURANCE
PA186730OtherADVANTRA PROVIDER NUMBER
PAV0069AOtherUPMC PROVIDER NUMBER
PA186730OtherHEALTH AMERICA PROV. NO.
PA226361OtherHEALTH AMERICA
PA1518391OtherGATEWAY PROVIDER NUMBER