Provider Demographics
NPI:1427239060
Name:HERITAGE HILLS HOME, INC.
Entity type:Organization
Organization Name:HERITAGE HILLS HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ANTASUDA
Authorized Official - Last Name:HANGAD
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR CERT
Authorized Official - Phone:925-944-0454
Mailing Address - Street 1:2323 HERITAGE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3173
Mailing Address - Country:US
Mailing Address - Phone:925-944-0454
Mailing Address - Fax:
Practice Address - Street 1:2041 MONO DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4917
Practice Address - Country:US
Practice Address - Phone:925-723-0144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07560049311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)