Provider Demographics
NPI:1346084399
Name:HEISMAN LLC
Entity type:Organization
Organization Name:HEISMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKINSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-206-2229
Mailing Address - Street 1:2266 LAVA RIDGE CT STE 105
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2856
Mailing Address - Country:US
Mailing Address - Phone:480-206-2229
Mailing Address - Fax:
Practice Address - Street 1:355 JOERSCHKE DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5288
Practice Address - Country:US
Practice Address - Phone:530-273-7247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility