Provider Demographics
NPI:1346297728
Name:AMERICAN HERITAGE HOME HEALTH CARE
Entity Type:Organization
Organization Name:AMERICAN HERITAGE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-336-9643
Mailing Address - Street 1:27301 DEQUINDRE RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3473
Mailing Address - Country:US
Mailing Address - Phone:248-336-9643
Mailing Address - Fax:248-336-2564
Practice Address - Street 1:27301 DEQUINDRE RD
Practice Address - Street 2:SUITE 214
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3473
Practice Address - Country:US
Practice Address - Phone:248-336-9643
Practice Address - Fax:248-336-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB0158X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-7594Medicare ID - Type UnspecifiedHOME HEALTH CARE