Provider Demographics
NPI:1235297185
Name:HERITAGE HOME CARE AGENCY INC.
Entity Type:Organization
Organization Name:HERITAGE HOME CARE AGENCY INC.
Other - Org Name:HERITAGE HOME CARE OF GREENSBORO INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICO
Authorized Official - Middle Name:AKIVA
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-763-2186
Mailing Address - Street 1:PO BOX 14896
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4896
Mailing Address - Country:US
Mailing Address - Phone:704-779-4667
Mailing Address - Fax:866-401-7629
Practice Address - Street 1:914 N ELM ST STE D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6319
Practice Address - Country:US
Practice Address - Phone:704-779-4667
Practice Address - Fax:866-401-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3586251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health