Provider Demographics
NPI:1407146459
Name:HERON HEALTH SERVICES, LLC.
Entity Type:Organization
Organization Name:HERON HEALTH SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ODAICHE
Authorized Official - Middle Name:TRACEY
Authorized Official - Last Name:ONYIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-718-2311
Mailing Address - Street 1:1600 31ST ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3633
Mailing Address - Country:US
Mailing Address - Phone:202-718-2311
Mailing Address - Fax:202-688-1848
Practice Address - Street 1:1629 K ST NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1602
Practice Address - Country:US
Practice Address - Phone:202-718-2311
Practice Address - Fax:202-688-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC27459XXXX-71101306253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care