Provider Demographics
NPI:1902022445
Name:HIGH PLAINS HEALTH PROVIDERS, INC.
Entity Type:Organization
Organization Name:HIGH PLAINS HEALTH PROVIDERS, INC.
Other - Org Name:CUMBERLAND COURT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:940-766-6751
Mailing Address - Street 1:1505 P B LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2631
Mailing Address - Country:US
Mailing Address - Phone:940-766-6751
Mailing Address - Fax:940-766-6753
Practice Address - Street 1:2114 8TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4109
Practice Address - Country:US
Practice Address - Phone:940-766-6751
Practice Address - Fax:940-766-6753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45G890Medicaid