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General NPI Number Information
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NPI Number | 1508720467
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Entity Type | Organization
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Legal Business Name | HERITAGE GROVE INC
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 13555 TERRITORIAL CIR N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4304
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Country | US
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Telephone | 571-789-5282
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Fax |
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Provider Business Mailing Address
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Address Line | 13555 TERRITORIAL CIR N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4304
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Country | US
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Telephone | 571-789-5282
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FAHIMA ABDULKADIR
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Credential |
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Telephone | 202-365-2191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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