Provider Demographics
NPI:1720088214
Name:HIGHLAND BEHAVIORAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:HIGHLAND BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:ADVANCE PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCWATTERS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:304-348-1401
Mailing Address - Street 1:1418 MACCORKLE AVE. SW
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1331
Mailing Address - Country:US
Mailing Address - Phone:304-348-1407
Mailing Address - Fax:304-348-1076
Practice Address - Street 1:1418 MACCORKLE AVE. SW
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1331
Practice Address - Country:US
Practice Address - Phone:304-348-1407
Practice Address - Fax:304-348-1076
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGHLAND BEHAVIORAL HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-26
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP0552265333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV8550025-000Medicaid
1302420001Medicare NSC
5790400001Medicare NSC