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General NPI Number Information
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NPI Number | 1558878926
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Entity Type | Organization
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Legal Business Name | HERITAGE RESOURCE INC.
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 16332 ELKHORN LN
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City | BOWIE
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State | MD
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Zip | 20716-3267
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Country | US
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Telephone | 301-395-7592
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Fax |
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Provider Business Mailing Address
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Address Line | 16332 ELKHORN LN
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City | BOWIE
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State | MD
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Zip | 20716-3267
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Country | US
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Telephone | 301-395-7592
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. ADENIKE OJETOLA
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Credential | MSW
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Telephone | 301-395-7592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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