Provider Demographics
NPI:1083869069
Name:HERITAGE BEHAVIORAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:HERITAGE BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BS, QP
Authorized Official - Phone:252-367-6236
Mailing Address - Street 1:510 2ND ST
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-7202
Mailing Address - Country:US
Mailing Address - Phone:252-746-4000
Mailing Address - Fax:866-847-2996
Practice Address - Street 1:510 2ND ST
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-7202
Practice Address - Country:US
Practice Address - Phone:252-746-4000
Practice Address - Fax:866-847-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health