Healthcare Provider Details

I. General information

NPI: 1144820226
Provider Name (Legal Business Name): HERITAGE HOME DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 N LEROY ST STE 6
FENTON MI
48430-2801
US

IV. Provider business mailing address

1580 N LEROY ST STE 6
FENTON MI
48430-2801
US

V. Phone/Fax

Practice location:
  • Phone: 586-419-4371
  • Fax:
Mailing address:
  • Phone: 810-215-8225
  • Fax: 989-459-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN HEIGHT
Title or Position: CEO/PRESIDENT
Credential: RN
Phone: 810-215-1082