NPIMap

Organization Active NPI

Highland Rivers CSB

Doing business as Highland Rivers Developmental Services Office

  • Community/Behavioral Health Agency
  • Dalton, GA
National Provider Identifier
1417010885
Registry record updated Sep 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
HIGHLAND RIVERS CSB
Doing business as
Highland Rivers Developmental Services Office
Practice address
407 N. Thornton Ave
Suite 5
Dalton, GA 30720-3549
Phone
(706) 270-5050
Fax
(706) 270-5052
NPI assigned
Dec 18, 2006
Last updated
Sep 20, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
HIGHLAND RIVERS CENTER, CSBAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 20, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jason Bearden
Title
Ceo
Phone
(706) 270-5000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X GA
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

407 N. Thornton Ave
Suite 5
Dalton, GA 30720-3549

Mailing address

1401 Applewood Drive
Suite 1
Dalton, GA 30720-2699
Phone (706) 270-5002

Other identifiers 1

IdentifierTypeStateIssuer
000601807GMedicaidGA

Other names 1

  • HIGHLAND RIVERS DEVELOPMENTAL SERVICES OFFICE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory
Part of
Highland Rivers Community Service Board

Locations

407 N Thornton Ave
Ste 5
Dalton, GA 30720
Phone (706) 270-5050

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316476800000",
    "number": "1417010885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 APPLEWOOD DRIVE",
            "address_2": "SUITE 1",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202699",
            "telephone_number": "706-270-5002",
            "fax_number": "706-370-7749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 N. THORNTON AVE",
            "address_2": "SUITE 5",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307203549",
            "telephone_number": "706-270-5050",
            "fax_number": "706-270-5052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND RIVERS CSB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HIGHLAND RIVERS CENTER, CSB",
        "enumeration_date": "2006-12-18",
        "last_updated": "2011-09-20",
        "status": "A",
        "authorized_official_last_name": "BEARDEN",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-270-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000601807G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HIGHLAND RIVERS DEVELOPMENTAL SERVICES OFFICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dalton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.