Healthcare Provider Details

I. General information

NPI: 1508924135
Provider Name (Legal Business Name): HERITAGE ADHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 N MILLBROOK AVE
FRESNO CA
93703-1425
US

IV. Provider business mailing address

3115 N MILLBROOK AVE
FRESNO CA
93703-1425
US

V. Phone/Fax

Practice location:
  • Phone: 559-222-0304
  • Fax: 559-222-2959
Mailing address:
  • Phone: 559-222-0304
  • Fax: 559-222-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. CHARLES WINFIELD
Title or Position: PROGRAM DIRECTOR
Credential: RN
Phone: 559-222-0304