Provider Demographics
NPI:1346804432
Name:HERITAGE GROUP HOMES, INC.
Entity Type:Organization
Organization Name:HERITAGE GROUP HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-599-8222
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:626-653-1000
Mailing Address - Fax:
Practice Address - Street 1:957 S VILLAGE OAKS DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3696
Practice Address - Country:US
Practice Address - Phone:909-599-8222
Practice Address - Fax:909-599-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of Service
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty