Provider Demographics
NPI:1437176427
Name:HERITAGE HILLS LIVING CENTER, LLC
Entity Type:Organization
Organization Name:HERITAGE HILLS LIVING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-269-3725
Mailing Address - Street 1:101 GRACE DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-9088
Mailing Address - Country:US
Mailing Address - Phone:864-269-3725
Mailing Address - Fax:864-295-3383
Practice Address - Street 1:2051 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-3203
Practice Address - Country:US
Practice Address - Phone:704-694-4106
Practice Address - Fax:704-694-6271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0090314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802904Medicaid
NC3415392Medicaid
NC3416086Medicaid
NC3426086Medicaid
NC3425392Medicaid
NCRH 7802904Medicaid
NC34-5392Medicare PIN
NC1104660001Medicare NSC
NC3426086Medicaid