Provider Demographics
NPI:1659032209
Name:HERITAGE OAKS LLC
Entity Type:Organization
Organization Name:HERITAGE OAKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:RHYNE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:980-505-4427
Mailing Address - Street 1:1020 HAVEN CIR APT G6
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-4831
Mailing Address - Country:US
Mailing Address - Phone:980-505-4427
Mailing Address - Fax:
Practice Address - Street 1:916 S MARIETTA ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5405
Practice Address - Country:US
Practice Address - Phone:980-505-4427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility