Provider Demographics
NPI:1306899091
Name:HERITAGE CLINIC AND THE COMMUNITY ASSISTANCE PROGRAM FOR SENIORS
Entity type:Organization
Organization Name:HERITAGE CLINIC AND THE COMMUNITY ASSISTANCE PROGRAM FOR SENIORS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VATCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELARTINIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:626-577-8480
Mailing Address - Street 1:447 N EL MOLINO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1403
Mailing Address - Country:US
Mailing Address - Phone:626-577-8480
Mailing Address - Fax:626-577-8978
Practice Address - Street 1:253 N SAN GABRIEL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3429
Practice Address - Country:US
Practice Address - Phone:626-577-8480
Practice Address - Fax:626-577-8978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251X00000X
CA2255549103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251X00000XAgenciesSupports BrokerageGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP17307Medicare UPIN
CAWC29350CMedicare UPIN
CAWCP12489AMedicare UPIN
CAWCP20690AMedicare UPIN
CAW15808Medicare UPIN
CAWCP20693AMedicare UPIN
CAWCP19264AMedicare UPIN
CAWCP14155AMedicare UPIN
CASW21721Medicare UPIN