Provider Demographics
NPI:1770835084
Name:HIGHLAND RIVERS COMMUNITY SERVICE BOARD
Entity Type:Organization
Organization Name:HIGHLAND RIVERS COMMUNITY SERVICE BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-270-5033
Mailing Address - Street 1:1401 APPLEWOOD DR STE 1
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2699
Mailing Address - Country:US
Mailing Address - Phone:706-270-5033
Mailing Address - Fax:706-370-7749
Practice Address - Street 1:18 ELBERT ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-8619
Practice Address - Country:US
Practice Address - Phone:706-270-5033
Practice Address - Fax:706-370-7749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000601807ZMedicaid