Provider Demographics
NPI:1003821695
Name:HERITAGE HOUSE OF NEW CASTLE
Entity Type:Organization
Organization Name:HERITAGE HOUSE OF NEW CASTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEPREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-529-2961
Mailing Address - Street 1:1023 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4002
Mailing Address - Country:US
Mailing Address - Phone:765-529-9694
Mailing Address - Fax:765-529-8816
Practice Address - Street 1:1023 N 20TH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4002
Practice Address - Country:US
Practice Address - Phone:765-529-9694
Practice Address - Fax:765-529-8816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060000351314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100266250Medicaid
IN155089Medicare Oscar/Certification