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General NPI Number Information
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NPI Number | 1013889880
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Entity Type | Organization
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Legal Business Name | HERITAGE ROAD GROUP HOME
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 3779 HERITAGE RD
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City | RAYNE
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State | LA
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Zip | 70578-7750
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Country | US
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Telephone | 337-367-6813
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Fax |
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Provider Business Mailing Address
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Address Line | 6400 HIGHWAY 90 W
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City | NEW IBERIA
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State | LA
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Zip | 70560-7836
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Country | US
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Telephone | 337-367-6813
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Fax |
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Authorized Official
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Title or Position | RESIDENTIAL DIRECTOR
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Name | BRANDI LEE BOOK STUTES
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Credential |
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Telephone | 337-367-6813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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