Provider Demographics
NPI:1669557989
Name:HERITAGE HOUSE OF VIRGINIA, INC.
Entity type:Organization
Organization Name:HERITAGE HOUSE OF VIRGINIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WESTBERRY
Authorized Official - Last Name:SAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-288-1699
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:GARRISONVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22463-0779
Mailing Address - Country:US
Mailing Address - Phone:540-288-1699
Mailing Address - Fax:540-657-9399
Practice Address - Street 1:1075 GARRISONVILLE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-8600
Practice Address - Country:US
Practice Address - Phone:540-288-1699
Practice Address - Fax:540-657-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA496320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities