Provider Demographics
NPI:1295165223
Name:HIGHLAND OPERATING CR LLC
Entity type:Organization
Organization Name:HIGHLAND OPERATING CR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YOSSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-370-8090
Mailing Address - Street 1:1050 BROADVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:BRACKENRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15014-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1050 BROADVIEW BLVD
Practice Address - Street 2:
Practice Address - City:BRACKENRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15014-1216
Practice Address - Country:US
Practice Address - Phone:724-224-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102862395Medicaid