Healthcare Provider Details

I. General information

NPI: 1407893779
Provider Name (Legal Business Name): HERITAGE HEALTHCARE HOLDINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5026 FARAON ST
SAINT JOSEPH MO
64506-3375
US

IV. Provider business mailing address

5026 FARAON ST
SAINT JOSEPH MO
64506-3375
US

V. Phone/Fax

Practice location:
  • Phone: 816-279-1591
  • Fax: 816-232-3775
Mailing address:
  • Phone: 816-279-1591
  • Fax: 816-232-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number032413
License Number StateMO

VIII. Authorized Official

Name: MR. LOWELL L FOX
Title or Position: PRESIDENT
Credential:
Phone: 816-233-1212