Healthcare Provider Details

I. General information

NPI: 1710388152
Provider Name (Legal Business Name): HERITAGE HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 N 10TH ST SUITE A3
ST AUGUSTINE FL
32084-1800
US

IV. Provider business mailing address

2617 OAKGROVE AVE
ST AUGUSTINE FL
32092-3602
US

V. Phone/Fax

Practice location:
  • Phone: 904-626-0311
  • Fax:
Mailing address:
  • Phone: 904-626-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RAJIV SINGH
Title or Position: OWNER
Credential:
Phone: 904-626-0311