Provider Demographics
NPI:1841731593
Name:THE HERITAGE ASSISTED LIVING & ADULT DAY CARE, LLC
Entity type:Organization
Organization Name:THE HERITAGE ASSISTED LIVING & ADULT DAY CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TREVAS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:YOUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-525-9215
Mailing Address - Street 1:854 LETTUCE LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-8808
Mailing Address - Country:US
Mailing Address - Phone:575-525-9215
Mailing Address - Fax:575-527-1729
Practice Address - Street 1:854 LETTUCE LN
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-8808
Practice Address - Country:US
Practice Address - Phone:575-525-9215
Practice Address - Fax:575-527-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261QA0600X
NM4021310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care