Healthcare Provider Details

I. General information

NPI: 1316140189
Provider Name (Legal Business Name): HERITAGE HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 DOUGLAS AVE
YORKVILLE NY
13495-1729
US

IV. Provider business mailing address

2350 DOUGLAS AVE
YORKVILLE NY
13495-1729
US

V. Phone/Fax

Practice location:
  • Phone: 315-736-3392
  • Fax:
Mailing address:
  • Phone: 315-736-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number4427770001
License Number StateNY

VIII. Authorized Official

Name: MRS. CATHY R SUNDERLIN
Title or Position: PRESIDENT
Credential:
Phone: 315-736-3392