Provider Demographics
NPI:1922030444
Name:HERITAGE HEALTH CENTER INC
Entity type:Organization
Organization Name:HERITAGE HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-697-5500
Mailing Address - Street 1:20696 BOND RD NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370
Mailing Address - Country:US
Mailing Address - Phone:360-697-5500
Mailing Address - Fax:360-697-5522
Practice Address - Street 1:20696 BOND RD NE
Practice Address - Street 2:SUITE 110
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-697-5500
Practice Address - Fax:360-697-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002493208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9641366Medicaid
WA8858879Medicare ID - Type Unspecified
WA9641366Medicaid