Healthcare Provider Details

I. General information

NPI: 1912067075
Provider Name (Legal Business Name): NEWARK HERITAGE PARTNERS I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SOUTH HARMONY ROAD
NEWARK DE
19713-3338
US

IV. Provider business mailing address

400 CENTRE STREET
NEWTON MA
02458-2094
US

V. Phone/Fax

Practice location:
  • Phone: 302-283-0540
  • Fax: 302-283-0543
Mailing address:
  • Phone: 617-796-8160
  • Fax: 301-963-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number1159
License Number StateDE

VIII. Authorized Official

Name: PAUL HOAGLAND
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 617-796-8292