Provider Demographics
NPI:1336437763
Name:HIGHLAND RIVERS CENTER, CSB
Entity Type:Organization
Organization Name:HIGHLAND RIVERS CENTER, CSB
Other - Org Name:ROME CRISIS UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-270-5002
Mailing Address - Street 1:1620 HICKORY ST
Mailing Address - Street 2:STE 406
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2312
Mailing Address - Country:US
Mailing Address - Phone:706-270-5002
Mailing Address - Fax:706-270-5111
Practice Address - Street 1:1 WOODBINE AVE NW
Practice Address - Street 2:NW
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2397
Practice Address - Country:US
Practice Address - Phone:706-314-0019
Practice Address - Fax:706-314-0343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGHLAND RIVERS CENTER, CSB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health