Provider Demographics
NPI:1376724591
Name:HIGHLAND GARDEN SUPPORTIVE LIVING
Entity Type:Organization
Organization Name:HIGHLAND GARDEN SUPPORTIVE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MISSALL
Authorized Official - Suffix:
Authorized Official - Credentials:CM
Authorized Official - Phone:414-257-4381
Mailing Address - Street 1:7425 HARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2626
Mailing Address - Country:US
Mailing Address - Phone:414-475-7788
Mailing Address - Fax:414-475-5215
Practice Address - Street 1:1818 W JUNEAU AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1184
Practice Address - Country:US
Practice Address - Phone:414-475-7788
Practice Address - Fax:414-475-5215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANEW HELATH CARE SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage