Provider Demographics
NPI:1700021722
Name:HIGHER HEIGHTS RESIDENTIAL SVC CTR LLC
Entity Type:Organization
Organization Name:HIGHER HEIGHTS RESIDENTIAL SVC CTR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MACK-MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-737-8406
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23705-0962
Mailing Address - Country:US
Mailing Address - Phone:757-737-8406
Mailing Address - Fax:
Practice Address - Street 1:1604 ELM AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4508
Practice Address - Country:US
Practice Address - Phone:757-737-8406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1036322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children