Provider Demographics
NPI:1962957696
Name:HIGHLANDS ASSISTED LIVING LLC
Entity type:Organization
Organization Name:HIGHLANDS ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-386-9607
Mailing Address - Street 1:3050 PEACHTREE RD NW
Mailing Address - Street 2:STE 570
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:64 CLUB HOUSE TRL
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28741-8100
Practice Address - Country:US
Practice Address - Phone:828-526-5251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-056-005310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility