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General NPI Number Information
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NPI Number | 1083612402
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Entity Type | Organization
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Legal Business Name | HERITAGE HEALTH CARE SYSTEMS, INC.
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Dates
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Enumeration Date | 07/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20180 GOVERNORS HWY SUITE 210
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1027
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Country | US
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Telephone | 708-283-8255
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Fax | 708-481-4847
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Provider Business Mailing Address
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Address Line | 20180 GOVERNORS HWY SUITE 210
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1027
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Country | US
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Telephone | 708-283-8255
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Fax | 708-481-4847
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. NAOMI R JENNINGS
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Credential | R.N.
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Telephone | 708-283-8852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1010296
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License Number State | IL
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