Provider Demographics
NPI:1639826746
Name:HERITAGE PLACE BUSINESS LLC
Entity Type:Organization
Organization Name:HERITAGE PLACE BUSINESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKARD
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:910-515-6786
Mailing Address - Street 1:114 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-6405
Mailing Address - Country:US
Mailing Address - Phone:910-515-6786
Mailing Address - Fax:
Practice Address - Street 1:1372 EUFOLA RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-2401
Practice Address - Country:US
Practice Address - Phone:704-528-4568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)