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General NPI Number Information
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NPI Number | 1467590562
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Entity Type | Organization
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Legal Business Name | HERITAGE HOUSE OF RICHMOND
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 2070 CHESTER BLVD
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City | RICHMOND
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State | IN
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Zip | 47374-1215
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Country | US
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Telephone | 765-962-3543
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Fax | 765-935-5060
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Provider Business Mailing Address
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Address Line | 2070 CHESTER BLVD
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City | RICHMOND
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State | IN
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Zip | 47374-1215
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Country | US
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Telephone | 765-962-3543
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Fax | 765-935-5060
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Authorized Official
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Title or Position | CORPORATE OFFICER
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Name | MRS. PAMELA DEPREZ
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Credential |
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Telephone | 765-529-2961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 06-000133-1
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License Number State | IN
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