Provider Demographics
NPI:1659616985
Name:HERITAGE HOME CARE OF CHARLOTTE
Entity type:Organization
Organization Name:HERITAGE HOME CARE OF CHARLOTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICO
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-763-2168
Mailing Address - Street 1:10610 METROMONT PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7607
Mailing Address - Country:US
Mailing Address - Phone:704-763-2168
Mailing Address - Fax:866-401-7629
Practice Address - Street 1:10610 METROMONT PKWY STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7607
Practice Address - Country:US
Practice Address - Phone:704-763-2168
Practice Address - Fax:866-401-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care