Provider Demographics
NPI:1780122606
Name:HERITAGE MEDICAL STAFFING INC
Entity type:Organization
Organization Name:HERITAGE MEDICAL STAFFING INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:WAMBUI
Authorized Official - Last Name:NJUKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-990-1134
Mailing Address - Street 1:23830 PACIFIC HWY S
Mailing Address - Street 2:SUITE # 333
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-7734
Mailing Address - Country:US
Mailing Address - Phone:206-519-0999
Mailing Address - Fax:253-344-1106
Practice Address - Street 1:23830 PACIFIC HWY S
Practice Address - Street 2:SUITE # 333
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-7734
Practice Address - Country:US
Practice Address - Phone:206-519-0999
Practice Address - Fax:253-344-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-11
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health