Provider Demographics
NPI:1447752936
Name:HIGHLAND HEALTH PROVIDERS CORP
Entity Type:Organization
Organization Name:HIGHLAND HEALTH PROVIDERS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADOWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-840-6617
Mailing Address - Street 1:1487 NORTH HIGH ST.
Mailing Address - Street 2:SUITE 102, ATTN: CFO
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133
Mailing Address - Country:US
Mailing Address - Phone:937-840-6617
Mailing Address - Fax:
Practice Address - Street 1:1402 N. HIGH STREET
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133
Practice Address - Country:US
Practice Address - Phone:937-393-4899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)