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General NPI Number Information
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NPI Number | 1033784426
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Entity Type | Organization
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Legal Business Name | HERITAGE GROUP HOMES INC.
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 670 W BASELINE RD
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City | SAN DIMAS
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State | CA
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Zip | 91773-1492
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Country | US
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Telephone | 909-599-8222
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Fax | 909-599-8223
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Provider Business Mailing Address
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Address Line | PO BOX 8400
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City | LA VERNE
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State | CA
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Zip | 91750-8400
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Country | US
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Telephone | 909-599-8222
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Fax | 909-599-8223
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MARIA SERRATOS
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Credential |
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Telephone | 909-599-8222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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