Provider Demographics
NPI:1407600851
Name:HERITAGE HOMES AFC
Entity Type:Organization
Organization Name:HERITAGE HOMES AFC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOLAJI
Authorized Official - Middle Name:S
Authorized Official - Last Name:INUOLAJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-532-4520
Mailing Address - Street 1:3324 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-3375
Mailing Address - Country:US
Mailing Address - Phone:269-532-4520
Mailing Address - Fax:
Practice Address - Street 1:3324 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-3375
Practice Address - Country:US
Practice Address - Phone:269-532-4520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty