Healthcare Provider Details

I. General information

NPI: 1780020370
Provider Name (Legal Business Name): HERITAGE POINTE SENIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N 4TH STREET
MARSHALL MI
56258
US

IV. Provider business mailing address

207 N 4TH STREET
MARSHALL MI
56258
US

V. Phone/Fax

Practice location:
  • Phone: 507-337-4330
  • Fax:
Mailing address:
  • Phone: 507-337-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateMN

VIII. Authorized Official

Name: TRICIA LIES
Title or Position: DIRECTOR FINANCIAL SERVICES
Credential:
Phone: 952-888-2923