Provider Demographics
NPI:1346969128
Name:HERITAGE PARTIAL CARE LLC
Entity Type:Organization
Organization Name:HERITAGE PARTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-684-9914
Mailing Address - Street 1:440 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-1932
Mailing Address - Country:US
Mailing Address - Phone:973-677-2273
Mailing Address - Fax:862-233-6450
Practice Address - Street 1:440 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-1932
Practice Address - Country:US
Practice Address - Phone:973-677-2273
Practice Address - Fax:862-233-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)