Healthcare Provider Details

I. General information

NPI: 1003122334
Provider Name (Legal Business Name): HERITAGE ADULT DAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 W 25TH AVE
GARY IN
46407-3524
US

IV. Provider business mailing address

741 W 25TH AVE
GARY IN
46407-3524
US

V. Phone/Fax

Practice location:
  • Phone: 219-886-1670
  • Fax: 219-886-1670
Mailing address:
  • Phone: 219-886-1670
  • Fax: 219-886-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateIN

VIII. Authorized Official

Name: ANGELA BIDDINGS
Title or Position: REGISTERED NURSE
Credential:
Phone: 219-886-1670