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General NPI Number Information
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NPI Number | 1881482917
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Entity Type | Organization
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Legal Business Name | HERITAGE CARE HOME OF AUSTIN
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 511 BUMGARNER INDUSTRIAL DR SW
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City | CONOVER
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State | NC
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Zip | 28613-9205
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Country | US
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Telephone | 704-704-2231
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Fax | 704-704-2234
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Provider Business Mailing Address
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Address Line | 42020 VILLAGE CENTER PLZ STE 120-176
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City | STONE RIDGE
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State | VA
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Zip | 20105-3034
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Country | US
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Telephone | 703-679-7861
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ASHLEY CARLISLE
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Credential |
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Telephone | 703-679-7861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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