Provider Demographics
NPI:1225035058
Name:HERITAGE CARE INC
Entity Type:Organization
Organization Name:HERITAGE CARE INC
Other - Org Name:ST THOMAS MORE NURSING & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAICEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-234-6677
Mailing Address - Street 1:4922 LASALLE RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3302
Mailing Address - Country:US
Mailing Address - Phone:301-864-2333
Mailing Address - Fax:301-864-1377
Practice Address - Street 1:5711 SARVIS AVE STE 100
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1363
Practice Address - Country:US
Practice Address - Phone:301-237-6677
Practice Address - Fax:301-576-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
MD14703200400314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPM9OtherBLUECROSS BLUESHIELDS
MD800680600Medicaid
MD215145Medicare ID - Type Unspecified
1304550001Medicare NSC