MEDICARE: HERITAGE HOMECARE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		NY
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1265874325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE HOMECARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	1906 KINGS HWY FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1314
Country	:	US
Telephone Number	:	917-655-1572
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 KINGS HWY FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1314
Country	:	US
Telephone Number	:	917-655-1572
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	ANDREY NOVIKOV
Credential	:
Telephone Number	:	718-750-3550

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	02/23/2023

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