=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497738447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERITAGE MANAGEMENT SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2005
-----------------------------------------------------
Last Update Date | 05/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5104 N FRANCIS AVE STE 100
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73118-6042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-778-6270
-----------------------------------------------------
Fax | 405-778-6276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5104 N FRANCIS AVE STE 100
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73118-6042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-778-6270
-----------------------------------------------------
Fax | 405-778-6276
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ADMINISTRATOR
-----------------------------------------------------
Name | MS. TERRI G KING
-----------------------------------------------------
Credential | CEO/OWNER
-----------------------------------------------------
Telephone | 405-778-6270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 7698
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------