Provider Demographics
NPI:1306398185
Name:HERITAGE GROUP HOMES, INC.
Entity Type:Organization
Organization Name:HERITAGE GROUP HOMES, INC.
Other - Org Name:HERITAGE YOUTH SERVICES 3
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-653-1000
Mailing Address - Street 1:PO BOX 8400
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-8400
Mailing Address - Country:US
Mailing Address - Phone:909-599-8222
Mailing Address - Fax:909-599-8223
Practice Address - Street 1:1923 E ECKERMAN AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1113
Practice Address - Country:US
Practice Address - Phone:626-332-4600
Practice Address - Fax:909-599-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA197801967322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty