Provider Demographics
NPI:1467904235
Name:HERITAGE GROUP HOMES, INC.
Entity Type:Organization
Organization Name:HERITAGE GROUP HOMES, INC.
Other - Org Name:HERITAGE YOUTH SERVICES 2
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-653-1000
Mailing Address - Street 1:PO BOX 8400
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-8400
Mailing Address - Country:US
Mailing Address - Phone:909-599-8222
Mailing Address - Fax:909-599-8223
Practice Address - Street 1:16226 E. BENWICK ST
Practice Address - Street 2:
Practice Address - City:VALINDA
Practice Address - State:CA
Practice Address - Zip Code:91744-1301
Practice Address - Country:US
Practice Address - Phone:626-917-0857
Practice Address - Fax:909-599-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191500101322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children