Provider Demographics
NPI:1952456857
Name:HERITAGE HOME HOSPICE, LLC
Entity type:Organization
Organization Name:HERITAGE HOME HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - HOME HEALTH & HOSPICE
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:VASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-781-1535
Mailing Address - Street 1:PO BOX 99278
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-9278
Mailing Address - Country:US
Mailing Address - Phone:248-824-6609
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:500 KIRTS BLVD STE 250
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4135
Practice Address - Country:US
Practice Address - Phone:248-837-4390
Practice Address - Fax:248-591-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041000120251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1041000102Medicaid
MI1041000102OtherSTATE HOSPICE LICENSE