Provider Demographics
NPI:1811487820
Name:HEAVEN'S HERITAGE INC.
Entity type:Organization
Organization Name:HEAVEN'S HERITAGE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN AMHERSTIA
Authorized Official - Middle Name:NERA
Authorized Official - Last Name:ARCENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-442-2675
Mailing Address - Street 1:22201 TAJANTA CT
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-4069
Mailing Address - Country:US
Mailing Address - Phone:909-442-2675
Mailing Address - Fax:
Practice Address - Street 1:22201 TAJANTA CT
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-4069
Practice Address - Country:US
Practice Address - Phone:909-442-2675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility