Organization
HIGHLAND RIVERS CSB
Active
Parent organization
HIGHLAND RIVERS CENTER, CSB
Other names
HIGHLAND RIVERS PAULDING OFFICE
Organization subpart
Yes
Provider details
NPI number
Legal business name
HIGHLAND RIVERS CENTER, CSB
Authorized official
MRS. MELANIE DALLAS (CEO)
(706) 270-5000
Entity
Organization
Contact information
Practice address
126 ENTERPRISE PATH, SUITE #202, HIRAM, GA 30141-2656
(678) 567-0920
(678) 567-0950
Mailing address
1503 N TIBBS RD STE 1, DALTON, GA 30720-2915
(706) 270-5033
(706) 370-7749
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
GA
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000759448Q
—
GA
01
—
10064018
AMERIGROUP PROVIDER ID
GA
01
—
815526000
MAGELLAN BEHAVIORAL HEALTH ID
GA
Enumeration date
12/18/2006
Last updated
11/04/2022
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