Provider Demographics
NPI:1740608843
Name:HIGHLANDS OF VAN BUREN, LLC
Entity Type:Organization
Organization Name:HIGHLANDS OF VAN BUREN, LLC
Other - Org Name:HIGHLANDS OF VAN BUREN HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:GUTHRIE
Authorized Official - Last Name:BRINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-410-8371
Mailing Address - Street 1:2 OFFICE PARK CIR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2509
Mailing Address - Country:US
Mailing Address - Phone:205-410-8371
Mailing Address - Fax:205-637-3378
Practice Address - Street 1:228 POINTER TRL W
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2266
Practice Address - Country:US
Practice Address - Phone:479-474-5276
Practice Address - Fax:479-471-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA045138Medicare Oscar/Certification