Provider Demographics
NPI:1780027342
Name:COMMUNITY HERITAGE CORPORATION
Entity Type:Organization
Organization Name:COMMUNITY HERITAGE CORPORATION
Other - Org Name:FAMILY HERITAGE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MERLIN
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-920-6885
Mailing Address - Street 1:1126 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3768
Mailing Address - Country:US
Mailing Address - Phone:909-920-6885
Mailing Address - Fax:909-920-6883
Practice Address - Street 1:1126 W FOOTHILL BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3768
Practice Address - Country:US
Practice Address - Phone:909-920-6885
Practice Address - Fax:909-920-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-14
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health