Provider Demographics
NPI:1326804527
Name:HERITAGE HEALTH NETWORK LLC
Entity Type:Organization
Organization Name:HERITAGE HEALTH NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:BOCO, BOCP, CEAC
Authorized Official - Phone:909-573-5690
Mailing Address - Street 1:7056 ARCHIBALD AVE STE 102-314
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8713
Mailing Address - Country:US
Mailing Address - Phone:866-744-1231
Mailing Address - Fax:909-966-4069
Practice Address - Street 1:3740 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2759
Practice Address - Country:US
Practice Address - Phone:866-744-1231
Practice Address - Fax:909-966-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty