Provider Demographics
NPI:1518090620
Name:HERITAGE HEALTH MANAGEMENT 2 LLC
Entity Type:Organization
Organization Name:HERITAGE HEALTH MANAGEMENT 2 LLC
Other - Org Name:BLUE SKY MANAGEMENT LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-233-1305
Mailing Address - Street 1:3000 NE 64TH STREET
Mailing Address - Street 2:
Mailing Address - City:GLADSTON
Mailing Address - State:MO
Mailing Address - Zip Code:64119
Mailing Address - Country:US
Mailing Address - Phone:816-454-5130
Mailing Address - Fax:816-459-9799
Practice Address - Street 1:15 WALLINGFORD DRIVE
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079
Practice Address - Country:US
Practice Address - Phone:816-858-2804
Practice Address - Fax:816-858-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13182C310400000X
MO035734310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266715408Medicaid