Provider Demographics
NPI:1821106477
Name:HERITAGE HOMEHEALTH CARE
Entity Type:Organization
Organization Name:HERITAGE HOMEHEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-796-3236
Mailing Address - Street 1:8212 LOUISIANA BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2105
Mailing Address - Country:US
Mailing Address - Phone:505-796-3200
Mailing Address - Fax:505-796-3234
Practice Address - Street 1:2006 BOTULPH RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5764
Practice Address - Country:US
Practice Address - Phone:888-237-8176
Practice Address - Fax:505-983-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN2403Medicaid
NMN2403Medicaid