Provider Demographics
NPI:1356395909
Name:HERITAGE HOUSE NURSING CENTER, INC
Entity type:Organization
Organization Name:HERITAGE HOUSE NURSING CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-238-4045
Mailing Address - Street 1:421 WEST COLUMBIA STREET
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2217
Mailing Address - Country:US
Mailing Address - Phone:518-274-4125
Mailing Address - Fax:518-274-4337
Practice Address - Street 1:2920 TIBBITS AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-7077
Practice Address - Country:US
Practice Address - Phone:518-274-4125
Practice Address - Fax:518-274-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4102311N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7419009OtherAETNA
NY009611OtherBLUE CROSS
NY012299OtherBLUE CROSS FEDERAL
NY10023491OtherCDPHP
NY000400107001OtherBLUE SHIELD OF NE NY
NY01365177Medicaid
NY335760Medicare ID - Type Unspecified