Provider Demographics
NPI:1326383662
Name:HERITAGE HHCARE,LLC
Entity Type:Organization
Organization Name:HERITAGE HHCARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANUELA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:CANCELLIERE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:330-923-5859
Mailing Address - Street 1:1013 PORTAGE TRL
Mailing Address - Street 2:# 1
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3047
Mailing Address - Country:US
Mailing Address - Phone:330-923-5859
Mailing Address - Fax:330-923-5851
Practice Address - Street 1:1013 PORTAGE TRL
Practice Address - Street 2:# 1
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3047
Practice Address - Country:US
Practice Address - Phone:330-923-5859
Practice Address - Fax:330-923-5851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERITAGE HOME HEALTHCARE OF CUY FALLS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2112499251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health