Provider Demographics
NPI:1114199882
Name:HERITAGE BOARD & CARE INC
Entity Type:Organization
Organization Name:HERITAGE BOARD & CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:PALAD
Authorized Official - Last Name:BALIWAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-433-7314
Mailing Address - Street 1:2330 E 15TH ST
Mailing Address - Street 2:HERITAGE BOARD & CARE
Mailing Address - City:LONGBEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804
Mailing Address - Country:US
Mailing Address - Phone:562-433-7314
Mailing Address - Fax:562-433-1316
Practice Address - Street 1:2330 E 15TH ST
Practice Address - Street 2:HERITAGE BOARD & CARE
Practice Address - City:LONGBEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-433-7314
Practice Address - Fax:562-433-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Single Specialty