Healthcare Provider Details

I. General information

NPI: 1376604934
Provider Name (Legal Business Name): HERRITAGE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N 100 W
HURRICANE UT
84737-1603
US

IV. Provider business mailing address

45 N 100 W
HURRICANE UT
84737-1603
US

V. Phone/Fax

Practice location:
  • Phone: 435-635-7678
  • Fax: 435-216-1155
Mailing address:
  • Phone: 435-635-7678
  • Fax: 435-216-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAM SEYMOUR
Title or Position: OWNER
Credential:
Phone: 435-635-7678