Provider Demographics
NPI:1447256243
Name:HIGHLAND RIVERS COMMUNITY SERVICE BOARD
Entity type:Organization
Organization Name:HIGHLAND RIVERS COMMUNITY SERVICE BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-270-5000
Mailing Address - Street 1:1503 N TIBBS RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2915
Mailing Address - Country:US
Mailing Address - Phone:706-270-5033
Mailing Address - Fax:706-370-7749
Practice Address - Street 1:1503 N TIBBS RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2915
Practice Address - Country:US
Practice Address - Phone:706-270-5000
Practice Address - Fax:706-270-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251S00000X, 320800000X
GA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1174686620OtherSUBPART NPI
GA1578626917OtherSUBPART NPI
GA1043373467OtherSUBPART NPI
GA1093878464OtherSUBPART NPI
GA1538222971OtherSUBPART NPI
GA1093879827OtherSUBPART NPI
GA1285798041OtherSUBPART NPI
GA1881758613OtherSUBPART NPI
GA1912060088OtherSUBPART NPI
GA300030794BMedicaid
GA1083777650OtherSUBPART NPI
GA1164585543OtherSUBPART NPI
GA1669536991OtherSUBPART NPI
GA1740343300OtherSUBPART NPI
GA1861555450OtherSUBPART NPI
GA1023172350OtherSUBPART NPI
GA1629131214OtherSUBPART NPI
GA1689737033OtherSUBPART NPI
GA1629131214OtherSUBPART NPI
GA300030794BMedicaid