Provider Demographics
NPI:1124874425
Name:HERITAGE CARE PLACE LLC
Entity type:Organization
Organization Name:HERITAGE CARE PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-726-4147
Mailing Address - Street 1:135 EAGLES WALK STE 100
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7205
Mailing Address - Country:US
Mailing Address - Phone:470-726-4147
Mailing Address - Fax:
Practice Address - Street 1:135 EAGLES WALK STE 100
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7205
Practice Address - Country:US
Practice Address - Phone:470-726-4147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty