Provider Demographics
NPI:1982943304
Name:HERITAGE HOMES, INC.
Entity Type:Organization
Organization Name:HERITAGE HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOORDIJK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-395-9311
Mailing Address - Street 1:400 136TH AVE
Mailing Address - Street 2:BLDG. 200, STE. 205
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2923
Mailing Address - Country:US
Mailing Address - Phone:616-395-9311
Mailing Address - Fax:616-395-9315
Practice Address - Street 1:400 136TH AVE
Practice Address - Street 2:BLDG. 200, STE. 205
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2923
Practice Address - Country:US
Practice Address - Phone:616-395-9311
Practice Address - Fax:616-395-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 320900000X
MIAM700009394320600000X
MIAS080078811320600000X
MIAS700012873320600000X
MIAS700012884320600000X
MIAS700066904320600000X
MIAS700067923320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities