Healthcare Provider Details

I. General information

NPI: 1801666235
Provider Name (Legal Business Name): HERITAGE HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E STATE HIGHWAY 88
JACKSON CA
95642-2134
US

IV. Provider business mailing address

820 E STATE HIGHWAY 88
JACKSON CA
95642-2134
US

V. Phone/Fax

Practice location:
  • Phone: 209-223-7040
  • Fax: 209-223-7606
Mailing address:
  • Phone: 209-223-7040
  • Fax: 209-223-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GARY JOHNSON
Title or Position: CEO
Credential: MD
Phone: 209-223-7040