MEDICARE: HERITAGE HEALTHCARE HOLDINGS 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	314000000X	Skilled Nursing Facility	032413	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972987915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE HEALTHCARE HOLDINGS INC

Provider Business Mailing Address
First Line	:	5026 FARAON ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3375
Country	:	US
Telephone Number	:	816-279-1591
Fax Number	:	816-232-3775

Provider Business Practice Location Address
First Line	:	5026 FARAON ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3375
Country	:	US
Telephone Number	:	816-279-1591
Fax Number	:	816-232-3775

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. GINA FOX
Credential	:
Telephone Number	:	816-390-5970

Provider Enumeration Date	:	07/18/2015
Last Update Date	:	07/21/2015

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