Provider Demographics
NPI:1104250083
Name:HEROES OF THE GAME, INC.
Entity type:Organization
Organization Name:HEROES OF THE GAME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:PARTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:815-262-0699
Mailing Address - Street 1:3028 N TRAINER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5815
Mailing Address - Country:US
Mailing Address - Phone:815-262-1431
Mailing Address - Fax:
Practice Address - Street 1:3028 N TRAINER RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5815
Practice Address - Country:US
Practice Address - Phone:815-262-1431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201300012C253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care