Provider Demographics
NPI:1053480079
Name:HERITAGE HOME CARE, INC
Entity Type:Organization
Organization Name:HERITAGE HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-386-8900
Mailing Address - Street 1:21 WOOTEN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-8773
Mailing Address - Country:US
Mailing Address - Phone:336-386-8900
Mailing Address - Fax:336-386-8971
Practice Address - Street 1:21 WOOTEN RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-8773
Practice Address - Country:US
Practice Address - Phone:336-386-8900
Practice Address - Fax:336-386-8971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2462251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409517Medicaid
NC6600921Medicaid