Healthcare Provider Details

I. General information

NPI: 1104137173
Provider Name (Legal Business Name): HERITAGE POINTE PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 SAVANNAH TERRACE
WENTZVILLE MO
63385-3741
US

IV. Provider business mailing address

228 SAVANNAH TERRACE
WENTZVILLE MO
63385-3741
US

V. Phone/Fax

Practice location:
  • Phone: 636-542-5400
  • Fax: 636-542-5520
Mailing address:
  • Phone: 636-542-5400
  • Fax: 636-542-5520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number038114
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number038114
License Number StateMO

VIII. Authorized Official

Name: MR. TIMOTHY S. BLATTEL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 636-240-6152