Provider Demographics
NPI:1376782656
Name:HERITAGE HOUSE NORTH
Entity Type:Organization
Organization Name:HERITAGE HOUSE NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:714-687-0077
Mailing Address - Street 1:321 N STATE COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2915
Mailing Address - Country:US
Mailing Address - Phone:717-468-7007
Mailing Address - Fax:714-687-0691
Practice Address - Street 1:321 N STATE COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2915
Practice Address - Country:US
Practice Address - Phone:717-468-7007
Practice Address - Fax:714-687-0691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300054IN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility