Healthcare Provider Details

I. General information

NPI: 1568677912
Provider Name (Legal Business Name): HERITAGE HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9656 68TH AVE
ALLENDALE MI
49401-8358
US

IV. Provider business mailing address

400 136TH AVE BLDG. 200, STE. 205
HOLLAND MI
49424-2923
US

V. Phone/Fax

Practice location:
  • Phone: 616-895-7104
  • Fax: 616-895-7105
Mailing address:
  • Phone: 616-395-9311
  • Fax: 616-395-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. DAWN E. NOORDIJK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 616-395-9311