Healthcare Provider Details

I. General information

NPI: 1841731593
Provider Name (Legal Business Name): THE HERITAGE ASSISTED LIVING & ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 LETTUCE LN
LAS CRUCES NM
88001-8808
US

IV. Provider business mailing address

854 LETTUCE LN
LAS CRUCES NM
88001-8808
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-9215
  • Fax: 575-527-1729
Mailing address:
  • Phone: 575-525-9215
  • Fax: 575-527-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number4021
License Number StateNM

VIII. Authorized Official

Name: MS. TREVAS ANN YOUNGER
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 575-525-9215