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General NPI Number Information
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NPI Number | 1508465089
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Entity Type | Organization
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Legal Business Name | HERITAGE CHILD AND ADULT CARE CENTER
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 1600 MONTE CARLO DR
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City | MANSFIELD
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State | TX
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Zip | 76063-6291
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Country | US
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Telephone | 817-987-8331
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Fax | 682-318-1811
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Provider Business Mailing Address
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Address Line | 1600 MONTE CARLO DR
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City | MANSFIELD
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State | TX
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Zip | 76063-6291
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Country | US
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Telephone |
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Fax | 682-318-1811
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | ADEYINKA ADEKANOLA
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Credential |
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Telephone | 817-987-8331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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