Provider Demographics
NPI:1205522778
Name:THE HIGHLANDS AT WYOMISSING
Entity type:Organization
Organization Name:THE HIGHLANDS AT WYOMISSING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-775-2300
Mailing Address - Street 1:2000 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2714
Mailing Address - Country:US
Mailing Address - Phone:610-775-2300
Mailing Address - Fax:610-775-9851
Practice Address - Street 1:2000 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2714
Practice Address - Country:US
Practice Address - Phone:610-775-2300
Practice Address - Fax:610-775-9851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HIGHLANDS AT WYOMISSING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-17
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based