Provider Demographics
NPI:1962490995
Name:HIGHLAND MANOR NURSING HOME INC.
Entity Type:Organization
Organization Name:HIGHLAND MANOR NURSING HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-990-1133
Mailing Address - Street 1:761 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-3722
Mailing Address - Country:US
Mailing Address - Phone:508-679-1411
Mailing Address - Fax:
Practice Address - Street 1:761 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3722
Practice Address - Country:US
Practice Address - Phone:508-679-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0913421Medicaid