1801115290 NPI number — HERITAGE SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801115290 NPI number — HERITAGE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERITAGE SERVICES
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:
1801115290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2003
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12402-2003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-652-3116
Provider Business Mailing Address Fax Number:
800-407-6897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
358 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12401-5164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-652-3116
Provider Business Practice Location Address Fax Number:
800-407-6897
Provider Enumeration Date:
05/25/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SUPERFIN
Authorized Official First Name:
MILA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-652-3116

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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