Provider Demographics
NPI:1083612402
Name:HERITAGE HEALTH CARE SYSTEMS, INC.
Entity Type:Organization
Organization Name:HERITAGE HEALTH CARE SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:R
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-283-8852
Mailing Address - Street 1:20180 GOVERNORS HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1027
Mailing Address - Country:US
Mailing Address - Phone:708-283-8255
Mailing Address - Fax:708-481-4847
Practice Address - Street 1:20180 GOVERNORS HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1027
Practice Address - Country:US
Practice Address - Phone:708-283-8255
Practice Address - Fax:708-481-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010296251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50298OtherBLUE CROSS BLUE SHIELD
IL7972570OtherAETNA
IL50298OtherBLUE CROSS BLUE SHIELD
IL7972570OtherAETNA