Provider Demographics
NPI:1366846685
Name:AMERICAN HERITAGE IN HOME CARE
Entity Type:Organization
Organization Name:AMERICAN HERITAGE IN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-741-4070
Mailing Address - Street 1:500 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-5469
Mailing Address - Country:US
Mailing Address - Phone:541-741-4070
Mailing Address - Fax:541-741-2823
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-5469
Practice Address - Country:US
Practice Address - Phone:541-741-4070
Practice Address - Fax:541-741-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2119253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care