Provider Demographics
NPI:1073719704
Name:HERITAGE CASE MANAGEMENT
Entity type:Organization
Organization Name:HERITAGE CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VIRTUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-228-2400
Mailing Address - Street 1:4 CHENELL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-8501
Mailing Address - Country:US
Mailing Address - Phone:603-228-2400
Mailing Address - Fax:603-228-9210
Practice Address - Street 1:4 CHENELL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-8501
Practice Address - Country:US
Practice Address - Phone:603-228-2400
Practice Address - Fax:603-228-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03221251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30591104Medicaid