Provider Demographics
NPI:1316029549
Name:HERITAGE HOME HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:HERITAGE HOME HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-796-3200
Mailing Address - Street 1:3721 RUTLEDGE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5566
Mailing Address - Country:US
Mailing Address - Phone:505-796-3200
Mailing Address - Fax:505-796-3234
Practice Address - Street 1:3721 RUTLEDGE RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5566
Practice Address - Country:US
Practice Address - Phone:505-796-3200
Practice Address - Fax:505-796-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3003251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ9365Medicaid
NMD1843Medicaid