1285186981 NPI number — HERITAGE GROUP HOMES, INC.

Table of content: (NPI 1285186981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285186981 NPI number — HERITAGE GROUP HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERITAGE GROUP HOMES, INC.
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:
HERITAGE YOUTH SERVICES 5
Provider Other Organization Name Type Code:
5
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:
1285186981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA VERNE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91750-8400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-599-8222
Provider Business Mailing Address Fax Number:
909-599-8223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1940 BASELINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA VERNE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91750-2148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-392-1344
Provider Business Practice Location Address Fax Number:
909-599-8223
Provider Enumeration Date:
10/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HEYER
Authorized Official First Name:
SANDI
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
626-653-1000

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: 197804065 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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