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General NPI Number Information
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NPI Number | 1528923422
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Entity Type | Organization
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Legal Business Name | HERITAGE HEALTH ALLIANCE SRL
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | CALLE ANTERA MOTA CENTRO DE LA CIUDAD SAN FELIPE
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City | PUERTO PLATA
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State | PUERTO PLATA
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Zip | 57000
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Country | DO
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 EAST BLVD SUITE E #811
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City | CHARLOTTE
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State | NC
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Zip | 28203
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Country | US
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Telephone | 829-526-0159
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | NYA T MOORE
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Credential |
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Telephone | 829-526-0159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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