Provider Demographics
NPI:1801115290
Name:HERITAGE SERVICES
Entity type:Organization
Organization Name:HERITAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUPERFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-652-3116
Mailing Address - Street 1:PO BOX 2003
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-2003
Mailing Address - Country:US
Mailing Address - Phone:800-652-3116
Mailing Address - Fax:800-407-6897
Practice Address - Street 1:358 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5164
Practice Address - Country:US
Practice Address - Phone:800-652-3116
Practice Address - Fax:800-407-6897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain