MEDICARE: HERITAGE HOUSE OF RICHMOND

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	314000000X	Skilled Nursing Facility	06-000133-1	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467590562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE HOUSE OF RICHMOND

Provider Business Mailing Address
First Line	:	2070 CHESTER BLVD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1215
Country	:	US
Telephone Number	:	765-962-3543
Fax Number	:	765-935-5060

Provider Business Practice Location Address
First Line	:	2070 CHESTER BLVD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1215
Country	:	US
Telephone Number	:	765-962-3543
Fax Number	:	765-935-5060

Authorized Official
Title or Position	:	CORPORATE OFFICER
Name	:	MRS. PAMELA DEPREZ
Credential	:
Telephone Number	:	765-529-2961

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	04/25/2008

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Directions to “HERITAGE HOUSE OF RICHMOND ” Practice Location

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