Provider Demographics
NPI:1932125770
Name:HERITAGE HOME HEALTHCARE & HOSPICE, INC
Entity Type:Organization
Organization Name:HERITAGE HOME HEALTHCARE & HOSPICE, INC
Other - Org Name:GOOD SAMARITAN SOCIETY - HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-362-3100
Mailing Address - Street 1:6700 JEFFERSON ST NE
Mailing Address - Street 2:SUITE D2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5567
Mailing Address - Country:US
Mailing Address - Phone:505-796-3200
Mailing Address - Fax:505-796-3234
Practice Address - Street 1:6700 JEFFERSON ST NE
Practice Address - Street 2:SUITE D2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5567
Practice Address - Country:US
Practice Address - Phone:505-796-3200
Practice Address - Fax:505-796-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3205251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM40884864Medicaid
NM321558Medicare PIN