Healthcare Provider Details

I. General information

NPI: 1982943304
Provider Name (Legal Business Name): HERITAGE HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

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 TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS080078811
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS700012873
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS700012884
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS700066904
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS700067923
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAM700009394
License Number StateMI

VIII. Authorized Official

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