Provider Demographics
NPI:1437451259
Name:HI-LAND MOUNTAIN HOMES
Entity Type:Organization
Organization Name:HI-LAND MOUNTAIN HOMES
Other - Org Name:ABOVE IT ALL ALCOHOL & DRUG TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KORY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVARELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-338-1234
Mailing Address - Street 1:PO BOX 1502
Mailing Address - Street 2:
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-1502
Mailing Address - Country:US
Mailing Address - Phone:909-338-1234
Mailing Address - Fax:
Practice Address - Street 1:27482 N. BAY ROAD.
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352
Practice Address - Country:US
Practice Address - Phone:909-338-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360082AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility