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General NPI Number Information
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NPI Number | 1487883476
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Entity Type | Organization
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Legal Business Name | HERITAGE HABILITATION INCORPORATED
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 07/10/2009
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Provider Practice Location Address
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Address Line | 746 E PIPELINE RD
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City | HURST
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State | TX
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Zip | 76053-6011
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Country | US
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Telephone | 817-899-1193
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Fax | 817-280-0200
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Provider Business Mailing Address
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Address Line | PO BOX 1405
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City | BEDFORD
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State | TX
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Zip | 76095-1405
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Country | US
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Telephone | 817-899-1193
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MR. HERYN ORI- ADE' DONALD
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Credential |
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Telephone | 817-899-1193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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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 | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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