Provider Demographics
NPI:1710388152
Name:HERITAGE HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:HERITAGE HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-626-0311
Mailing Address - Street 1:2617 OAKGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3602
Mailing Address - Country:US
Mailing Address - Phone:904-626-0311
Mailing Address - Fax:
Practice Address - Street 1:2825 N 10TH ST
Practice Address - Street 2:SUITE A3
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-1800
Practice Address - Country:US
Practice Address - Phone:904-626-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health