Healthcare Provider Details

I. General information

NPI: 1821106477
Provider Name (Legal Business Name): HERITAGE HOMEHEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 BOTULPH RD 2ND FLOOR
SANTA FE NM
87505-5764
US

IV. Provider business mailing address

8212 LOUISIANA BLVD NE
ALBUQUERQUE NM
87113-2105
US

V. Phone/Fax

Practice location:
  • Phone: 888-237-8176
  • Fax: 505-983-8887
Mailing address:
  • Phone: 505-796-3200
  • Fax: 505-796-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNM

VIII. Authorized Official

Name: MR. STEVE BOURNE
Title or Position: CFO
Credential:
Phone: 505-796-3236