Provider Demographics
NPI:1710480355
Name:HERITAGE ADULT ENRICHMENT CENTER, LLC
Entity Type:Organization
Organization Name:HERITAGE ADULT ENRICHMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MALTS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-677-2273
Mailing Address - Street 1:335 S PINE AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-1806
Mailing Address - Country:US
Mailing Address - Phone:856-207-3364
Mailing Address - Fax:
Practice Address - Street 1:440 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-1932
Practice Address - Country:US
Practice Address - Phone:973-677-2273
Practice Address - Fax:862-233-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ07025261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care