Provider Demographics
NPI:1164506879
Name:HERITAGE CENTER, LLC
Entity Type:Organization
Organization Name:HERITAGE CENTER, LLC
Other - Org Name:HERITAGE PLANTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:TUTTLE
Authorized Official - Last Name:LOFLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-853-7670
Mailing Address - Street 1:1025 LAMB RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-5229
Mailing Address - Country:US
Mailing Address - Phone:336-853-7670
Mailing Address - Fax:336-853-7671
Practice Address - Street 1:2809 OLD CONCORD RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-1339
Practice Address - Country:US
Practice Address - Phone:704-637-5465
Practice Address - Fax:704-637-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804918OtherPROVIDER NUMBER