Healthcare Provider Details

I. General information

NPI: 1992317291
Provider Name (Legal Business Name): HERITAGE PARK OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37135 COLEMAN AVE
DADE CITY FL
33525-4526
US

IV. Provider business mailing address

2123 CENTRE POINTE BLVD
TALLAHASSEE FL
32308-4930
US

V. Phone/Fax

Practice location:
  • Phone: 352-567-8615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SOLOMON KLEIN
Title or Position: MEMBER
Credential:
Phone: 352-567-8615