Healthcare Provider Details

I. General information

NPI: 1588640833
Provider Name (Legal Business Name): HERITAGE HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 WOODLAND LOOP
BARTLESVILLE OK
74006-5224
US

IV. Provider business mailing address

1244 WOODLAND LOOP
BARTLESVILLE OK
74006-5224
US

V. Phone/Fax

Practice location:
  • Phone: 918-335-3222
  • Fax: 918-333-5111
Mailing address:
  • Phone: 918-335-3222
  • Fax: 918-333-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH74057405
License Number StateOK

VIII. Authorized Official

Name: MS. LISA ROLL
Title or Position: ADMINISTRATOR
Credential: 2984
Phone: 918-335-3222