Provider Demographics
NPI:1588636344
Name:THE HIGHLANDS AT WYOMISSING
Entity Type:Organization
Organization Name:THE HIGHLANDS AT WYOMISSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-775-2300
Mailing Address - Street 1:2000 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2714
Mailing Address - Country:US
Mailing Address - Phone:610-775-2300
Mailing Address - Fax:610-775-9851
Practice Address - Street 1:2000 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2714
Practice Address - Country:US
Practice Address - Phone:610-775-2300
Practice Address - Fax:610-775-9851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA089602OtherPA DEPT OF HEALTH LICENSE
PA75-31833-9OtherSALES TAX EXEMPTION NUMBE
PA089602OtherPA DEPT OF HEALTH LICENSE