Provider Demographics
NPI:1487824843
Name:HERITAGE HOUSE HUMAN SERVICES INC
Entity Type:Organization
Organization Name:HERITAGE HOUSE HUMAN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:I
Authorized Official - Credentials:BS COMM HEALTH
Authorized Official - Phone:917-501-8029
Mailing Address - Street 1:3557 N SHARON AMITY RD STE 100-103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-8849
Mailing Address - Country:US
Mailing Address - Phone:917-501-8029
Mailing Address - Fax:
Practice Address - Street 1:3557 N SHARON AMITY RD
Practice Address - Street 2:SUITE # 100-103
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-8849
Practice Address - Country:US
Practice Address - Phone:917-501-8029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-01
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251X00000XAgenciesSupports Brokerage