Provider Demographics
NPI:1689076911
Name:HEROES PLACE
Entity Type:Organization
Organization Name:HEROES PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAME MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:N
Authorized Official - Last Name:NTHIGA
Authorized Official - Suffix:
Authorized Official - Credentials:R
Authorized Official - Phone:214-714-2553
Mailing Address - Street 1:127 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4729
Mailing Address - Country:US
Mailing Address - Phone:214-714-2553
Mailing Address - Fax:
Practice Address - Street 1:127 BROOKWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4729
Practice Address - Country:US
Practice Address - Phone:214-714-2553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233948320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities