Provider Demographics
NPI:1164410783
Name:HERITAGE CARE, LLC
Entity Type:Organization
Organization Name:HERITAGE CARE, LLC
Other - Org Name:HERITAGE REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:310-320-8714
Mailing Address - Street 1:21414 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1935
Mailing Address - Country:US
Mailing Address - Phone:310-320-8714
Mailing Address - Fax:310-320-1809
Practice Address - Street 1:21414 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1935
Practice Address - Country:US
Practice Address - Phone:310-320-8714
Practice Address - Fax:310-320-1809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06308IMedicaid
CAZZT06308IMedicaid