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General NPI Number Information
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NPI Number | 1427316553
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Entity Type | Organization
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Legal Business Name | HERITAGE CARE, INC
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 5711 SARVIS AVE STE 100
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City | RIVERDALE
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State | MD
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Zip | 20737-1363
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Country | US
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Telephone | 301-237-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 5711 SARVIS AVE STE 100
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City | RIVERDALE
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State | MD
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Zip | 20737-1363
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Country | US
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Telephone | 301-864-2333
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Fax | 301-237-6677
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JUAN CAICEDO
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Credential |
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Telephone | 301-237-6677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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