Healthcare Provider Details

I. General information

NPI: 1164410783
Provider Name (Legal Business Name): HERITAGE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21414 S VERMONT AVE
TORRANCE CA
90502-1935
US

IV. Provider business mailing address

21414 S VERMONT AVE
TORRANCE CA
90502-1935
US

V. Phone/Fax

Practice location:
  • Phone: 310-320-8714
  • Fax: 310-320-1809
Mailing address:
  • Phone: 310-320-8714
  • Fax: 310-320-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: ROY D MARTINEZ
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 310-320-8714