Provider Demographics
NPI:1790156750
Name:HEALTHPRO HERITAGE AT HOME LLC
Entity type:Organization
Organization Name:HEALTHPRO HERITAGE AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR LICENSING AND CERTIFICATIO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGLASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-406-3997
Mailing Address - Street 1:307 INTERNATIONAL CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1387
Mailing Address - Country:US
Mailing Address - Phone:615-406-3997
Mailing Address - Fax:
Practice Address - Street 1:24 TABOR XING
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1779
Practice Address - Country:US
Practice Address - Phone:615-406-3997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
IA408856251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2632Medicare PIN
IAIB3390Medicare PIN