Provider Demographics
NPI:1447763628
Name:AMERICARE AT HERITAGE PLACE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:AMERICARE AT HERITAGE PLACE ASSISTED LIVING LLC
Other - Org Name:HERITAGE PLACE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:214 N SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-4146
Mailing Address - Country:US
Mailing Address - Phone:573-471-1113
Mailing Address - Fax:
Practice Address - Street 1:1735 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-4754
Practice Address - Country:US
Practice Address - Phone:573-471-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000OtherNONE AT THIS TIME