Provider Demographics
NPI:1598898645
Name:HIGHLAND HALL ASSISTED LIVINGLLC
Entity Type:Organization
Organization Name:HIGHLAND HALL ASSISTED LIVINGLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-264-8417
Mailing Address - Street 1:1173 HIGHLAND HALL RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6790
Mailing Address - Country:US
Mailing Address - Phone:828-264-8417
Mailing Address - Fax:828-265-3517
Practice Address - Street 1:1173 HIGHLAND HALL RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6790
Practice Address - Country:US
Practice Address - Phone:828-264-8417
Practice Address - Fax:828-265-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-095007310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805140Medicaid