Provider Demographics
NPI:1972987915
Name:HERITAGE HEALTHCARE HOLDINGS INC
Entity type:Organization
Organization Name:HERITAGE HEALTHCARE HOLDINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-390-5970
Mailing Address - Street 1:5026 FARAON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3375
Mailing Address - Country:US
Mailing Address - Phone:816-279-1591
Mailing Address - Fax:816-232-3775
Practice Address - Street 1:5026 FARAON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3375
Practice Address - Country:US
Practice Address - Phone:816-279-1591
Practice Address - Fax:816-232-3775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032413314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101478006Medicaid
MO1407893779Medicare Oscar/Certification