Provider Demographics
NPI:1417150467
Name:HERYN DONALD
Entity Type:Organization
Organization Name:HERYN DONALD
Other - Org Name:HERITAGE HABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HERYN
Authorized Official - Middle Name:O
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-791-9040
Mailing Address - Street 1:1001 CAROUSEL DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3376
Mailing Address - Country:US
Mailing Address - Phone:817-791-9040
Mailing Address - Fax:817-590-8305
Practice Address - Street 1:1001 CAROUSEL DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3376
Practice Address - Country:US
Practice Address - Phone:817-791-9040
Practice Address - Fax:817-590-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities