Provider Demographics
NPI:1790132660
Name:HERITAGE VILLAGE 6 LLC
Entity Type:Organization
Organization Name:HERITAGE VILLAGE 6 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-388-1499
Mailing Address - Street 1:8035 E BROWN RD
Mailing Address - Street 2:BLDG#6
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-3901
Mailing Address - Country:US
Mailing Address - Phone:480-388-1499
Mailing Address - Fax:
Practice Address - Street 1:8035 E BROWN RD
Practice Address - Street 2:BLDG#6
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3901
Practice Address - Country:US
Practice Address - Phone:480-388-1499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9268C310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility