Provider Demographics
NPI:1619231974
Name:HERITAGE EAST ADULT DAYCARE CENTER, INC.
Entity Type:Organization
Organization Name:HERITAGE EAST ADULT DAYCARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALANIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:817-534-1935
Mailing Address - Street 1:1401 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-9143
Mailing Address - Country:US
Mailing Address - Phone:817-534-1935
Mailing Address - Fax:
Practice Address - Street 1:150 S BEACH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-1162
Practice Address - Country:US
Practice Address - Phone:817-534-1935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care