Healthcare Provider Details

I. General information

NPI: 1053257170
Provider Name (Legal Business Name): RAE OF HOPE HERITAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49497 HIGHWAY 49
ANNAPOLIS MO
63620-7800
US

IV. Provider business mailing address

49497 HIGHWAY 49
ANNAPOLIS MO
63620-7800
US

V. Phone/Fax

Practice location:
  • Phone: 573-307-1766
  • Fax: 573-307-1766
Mailing address:
  • Phone: 573-307-1766
  • Fax: 573-307-1766

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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIN MICHELLE MERTENS
Title or Position: OWNER
Credential: CNA
Phone: 573-307-1766