Provider Demographics
NPI:1154611879
Name:HERITAGE HEALTH INVESTORS 2, LLC
Entity type:Organization
Organization Name:HERITAGE HEALTH INVESTORS 2, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-771-2155
Mailing Address - Street 1:PO BOX 10276
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0276
Mailing Address - Country:US
Mailing Address - Phone:928-771-2155
Mailing Address - Fax:928-443-9332
Practice Address - Street 1:10619 N HAYDEN RD
Practice Address - Street 2:SUITE A-105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-8510
Practice Address - Country:US
Practice Address - Phone:602-287-0003
Practice Address - Fax:602-287-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
AZ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health