1700077443 NPI number — HERITAGE CHRISTIAN SERVICES INC

Table of content: (NPI 1700077443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700077443 NPI number — HERITAGE CHRISTIAN SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERITAGE CHRISTIAN SERVICES 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:
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:
1700077443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
349 WEST COMMERCIAL STREET
Provider Second Line Business Mailing Address:
SUITE 2795
Provider Business Mailing Address City Name:
EAST ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-340-2000
Provider Business Mailing Address Fax Number:
585-340-2006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
349 WEST COMMERCIAL STREET
Provider Second Line Business Practice Location Address:
SUITE 2795
Provider Business Practice Location Address City Name:
EAST ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-340-2000
Provider Business Practice Location Address Fax Number:
585-340-2006
Provider Enumeration Date:
08/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GEITNER
Authorized Official First Name:
MARISA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
585-340-2000

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1901L001 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01960663 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01750650 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02587300 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01522623 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01999499 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02119244 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02532841 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01984918 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02171153 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02463207 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02610997 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01855852 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02594301 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02594310 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01999366 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02247276 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02266888 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02416228 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02557959 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02596110 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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