Provider Demographics
NPI:1811237365
Name:A HERITAGE CHILD NETWORK, INC
Entity Type:Organization
Organization Name:A HERITAGE CHILD NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:LENA
Authorized Official - Last Name:VINSON-NNAJI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:704-619-3490
Mailing Address - Street 1:7633 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:BOX 10
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3909
Mailing Address - Country:US
Mailing Address - Phone:704-619-3490
Mailing Address - Fax:704-849-5251
Practice Address - Street 1:808 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-3800
Practice Address - Country:US
Practice Address - Phone:704-619-3490
Practice Address - Fax:704-849-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YP2500X261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275657132Medicaid
NC1578734646Medicaid