Provider Demographics
NPI:1225035058
Name:HERITAGE CARE INC
Entity type:Organization
Organization Name:HERITAGE CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAICEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-237-6677
Mailing Address - Street 1:4922 LASALLE RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3302
Mailing Address - Country:US
Mailing Address - Phone:301-237-6677
Mailing Address - Fax:301-576-3987
Practice Address - Street 1:4922A LASALLE RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3302
Practice Address - Country:US
Practice Address - Phone:301-237-6677
Practice Address - Fax:301-576-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPM9OtherBLUECROSS BLUESHIELDS
MD800680600Medicaid
MD215145Medicare ID - Type Unspecified
1304550001Medicare NSC