Provider Demographics
NPI:1508465089
Name:HERITAGE CHILD AND ADULT CARE CENTER
Entity Type:Organization
Organization Name:HERITAGE CHILD AND ADULT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ADEYINKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEKANOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-987-8331
Mailing Address - Street 1:1600 MONTE CARLO DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6291
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:682-318-1811
Practice Address - Street 1:1600 MONTE CARLO DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6291
Practice Address - Country:US
Practice Address - Phone:817-987-8331
Practice Address - Fax:682-318-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)