Provider Demographics
NPI:1043293087
Name:HERITAGE HOME HEALTH LLC
Entity Type:Organization
Organization Name:HERITAGE HOME HEALTH LLC
Other - Org Name:CHOICE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF GROWTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:903-932-1852
Mailing Address - Street 1:6760 OLD JACKSONVILLE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0572
Mailing Address - Country:US
Mailing Address - Phone:903-561-7250
Mailing Address - Fax:903-561-7424
Practice Address - Street 1:3535 BRIARPARK DR STE 220A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-5245
Practice Address - Country:US
Practice Address - Phone:979-848-8925
Practice Address - Fax:979-848-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003340251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXKO6772209Medicaid
TXKO6772209Medicaid