Highland Rivers CSB
Organization Active NPI Community/Behavioral Health Agency · Ellijay, GA
NPI 1083777650 · NPPES record last updated Sep 20, 2011
Key facts
- NPI
- 1083777650
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- HIGHLAND RIVERS CSB
- Practice address
- 18090 Highway 515 N
Ellijay, GA 30536-1331 - Phone
- (706) 276-2024
- Fax
- (706) 276-1502
- NPI assigned
- Dec 18, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- HIGHLAND RIVERS CENTER, CSB
Authorized official
- Name
- Mr. Jason Bearden
- Title
- Ceo
- Phone
- (706) 270-5000
Other NPIs on the same Medicare enrollment 16
Corporate family (same tax ID) 24
Practitioners 4
-
James Paul Brook, LCSW, LICSW, LCADC
-
Eamon O Dowling, LCSW
-
Maria C Jorgensen, CNS
-
Nasira Rubina, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040324001204 | GA | Part B Supplier - Clinic/Group Practice | 9032000245 |
Receives reassigned benefits from 146 practitioners 16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rome, GA; Smyrna, GA; Marietta, GA; Jasper, GA; Hiram, GA; Ellijay, GA; Dalton, GA; Cedartown, GA… |
National Provider Directory
- Tax ID family
- Highland Rivers Center CSB
- Part of
- Highland Rivers Center CSB
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | GA | ||
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
18090 Highway 515 N
Ellijay, GA 30536-1331
Mailing address
1401 Applewood Drive
Suite 1
Dalton, GA 30720-2699
Phone (706) 270-5002
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000936559FH | Medicaid | GA | |
| 1447256243 | Other | GA | ORGANIZATION MASTER NPI |
Other names
- Highland Rivers Fannin/Gilmer County Office
Other providers in Ellijay, GA
- Highland Rivers Community Service Board
- Highland Rivers Community Service Board
- Highland Rivers Community Service Board
- Highland Rivers Community Service Board
- Highland Rivers Community Service Board
- Justin Hildreth
- Holcombs Foot and Leg Clinics of Cumming
- Larry Hooks
- Tracy Hooper
- Hope Ambulance LLC
All providers in Ellijay, GA · Community/Behavioral Health Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.