Provider Demographics
NPI:1710050554
Name:HIGHLAND CARE CENTER, INC
Entity Type:Organization
Organization Name:HIGHLAND CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MORDECAI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIDELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-657-6363
Mailing Address - Street 1:9131 175TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5517
Mailing Address - Country:US
Mailing Address - Phone:718-657-6363
Mailing Address - Fax:718-657-2725
Practice Address - Street 1:9131 175TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5517
Practice Address - Country:US
Practice Address - Phone:718-657-6363
Practice Address - Fax:718-657-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003363N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01108727Medicaid
NY335505Medicare ID - Type Unspecified