1295905727 NPI number — HERON RIDGE ASSOCIATES PLC

Table of content: (NPI 1295905727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295905727 NPI number — HERON RIDGE ASSOCIATES PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERON RIDGE ASSOCIATES PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295905727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3694 CLARKSTON RD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
CLARKSTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48348-5213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-693-8880
Provider Business Mailing Address Fax Number:
248-391-7478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 280
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48170-2089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-454-3560
Provider Business Practice Location Address Fax Number:
734-454-3570
Provider Enumeration Date:
03/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RICHELSON
Authorized Official First Name:
ELLIOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, SECRETARY, TREASURER
Authorized Official Telephone Number:
904-605-4986

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  822246 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 463240 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910408 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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