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General NPI Number Information
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NPI Number | 1174962666
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Entity Type | Organization
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Legal Business Name | HERITAGE HHC (ABG), LLC
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 4801 MUNSON ST NW
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City | CANTON
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State | OH
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Zip | 44718-3614
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Country | US
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Telephone | 855-326-4790
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Fax | 330-494-8281
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Provider Business Mailing Address
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Address Line | 3416 STILLWATER AVE NW
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City | CANTON
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State | OH
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Zip | 44708-5867
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Country | US
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Telephone | 855-326-4790
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Fax | 330-494-8281
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MRS. ANASTACIA ERESE CLEMENTE
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Credential |
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Telephone | 855-326-4790
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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 |
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License Number State |
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