Provider Demographics
NPI:1942553573
Name:HERITAGE PLACE MANAGEMENT LLC
Entity Type:Organization
Organization Name:HERITAGE PLACE MANAGEMENT LLC
Other - Org Name:HERITAGE PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-478-4117
Mailing Address - Street 1:1800 SW 1ST AVE
Mailing Address - Street 2:# 180
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5362
Mailing Address - Country:US
Mailing Address - Phone:503-684-1123
Mailing Address - Fax:503-684-2533
Practice Address - Street 1:1150 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6351
Practice Address - Country:US
Practice Address - Phone:801-298-3241
Practice Address - Fax:801-298-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility