Provider Demographics
NPI:1700295417
Name:HERITAGE REHABILITATION SERVICES INC
Entity Type:Organization
Organization Name:HERITAGE REHABILITATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:UBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-250-6898
Mailing Address - Street 1:1606 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-6644
Mailing Address - Country:US
Mailing Address - Phone:832-250-6898
Mailing Address - Fax:713-785-4806
Practice Address - Street 1:1606 CENTER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-6644
Practice Address - Country:US
Practice Address - Phone:832-250-6898
Practice Address - Fax:713-785-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health