Healthcare Provider Details

I. General information

NPI: 1942196811
Provider Name (Legal Business Name): HERITAGE HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BALTIMORE AVE STE 300
RIVERDALE PARK MD
20737-1054
US

IV. Provider business mailing address

6200 BALTIMORE AVE STE 300
RIVERDALE PARK MD
20737-1054
US

V. Phone/Fax

Practice location:
  • Phone: 312-868-4509
  • Fax:
Mailing address:
  • Phone: 301-613-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ONYEBUCHI UKAEJE
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 312-868-4509