Provider Demographics
NPI:1801294293
Name:HIGHLAND RECOVERY CENTER
Entity type:Organization
Organization Name:HIGHLAND RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-270-5000
Mailing Address - Street 1:1401 APPLEWOOD DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720
Mailing Address - Country:US
Mailing Address - Phone:706-270-5033
Mailing Address - Fax:770-370-7749
Practice Address - Street 1:323 ROLAND ROAD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143
Practice Address - Country:US
Practice Address - Phone:706-253-1112
Practice Address - Fax:706-253-1120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGHLAND RIVERS COMMUNITY SERVICE BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP2111Medicare PIN