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General NPI Number Information
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NPI Number | 1205604550
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Entity Type | Organization
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Legal Business Name | HERITAGE HEALTH NETWORK LLC
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Dates
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Enumeration Date | 12/15/2023
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 2155 CHICAGO AVE STE 201
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City | RIVERSIDE
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State | CA
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Zip | 92507-2209
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Country | US
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Telephone | 866-744-1231
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Fax | 909-966-4069
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Provider Business Mailing Address
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Address Line | 2155 CHICAGO AVE STE 201
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City | RIVERSIDE
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State | CA
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Zip | 92507-2209
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Country | US
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Telephone | 866-744-1231
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Fax | 909-966-4069
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Authorized Official
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Title or Position | CEO
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Name | MR. CAMERON MICHAEL STEWART
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Credential |
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Telephone | 909-573-5690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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