Healthcare Provider Details

I. General information

NPI: 1841320249
Provider Name (Legal Business Name): HERITAGE CARE OF ROCKY MOUNT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COKEY RD
ROCKY MOUNT NC
27801-6925
US

IV. Provider business mailing address

PO BOX 878
OAK RIDGE NC
27310-0878
US

V. Phone/Fax

Practice location:
  • Phone: 252-977-6199
  • Fax: 252-977-6510
Mailing address:
  • Phone: 336-643-0555
  • Fax: 336-643-0553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHAL-033-005
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL-033-005
License Number StateNC

VIII. Authorized Official

Name: MRS. JACKIE PIERCE
Title or Position: MANAGING PARTNER
Credential:
Phone: 336-643-0555