MEDICARE: HERITAGE PARK OF WEST DELRAY, LLLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1366703316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE PARK OF WEST DELRAY, LLLP

Provider Business Mailing Address
First Line	:	14565 SIMS RD
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8549
Country	:	US
Telephone Number	:	561-499-9656
Fax Number	:

Provider Business Practice Location Address
First Line	:	5859 HERITAGE PARK WAY
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8557
Country	:	US
Telephone Number	:	561-499-7744
Fax Number	:

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	ROBERT G SCHEMEL
Credential	:
Telephone Number	:	561-499-9656

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	06/06/2012

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