Provider Demographics
NPI:1023234747
Name:HERITAGE CLINIC AND THE COMMUNITY ASSISTANCE PROGRAM FOR SENIORS
Entity type:Organization
Organization Name:HERITAGE CLINIC AND THE COMMUNITY ASSISTANCE PROGRAM FOR SENIORS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:VATCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELARTINIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:626-577-8480
Mailing Address - Street 1:447 N EL MOLINO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1403
Mailing Address - Country:US
Mailing Address - Phone:626-577-8480
Mailing Address - Fax:626-577-8978
Practice Address - Street 1:43807 10TH ST W STE D
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4805
Practice Address - Country:US
Practice Address - Phone:661-575-9365
Practice Address - Fax:661-575-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19717103TC0700X
171M00000X, 251X00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251X00000XAgenciesSupports BrokerageGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY19717Medicare UPIN