Provider Demographics
NPI:1942273933
Name:HERITAGE HEALTH CARE, INC.
Entity type:Organization
Organization Name:HERITAGE HEALTH CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:KILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-796-2595
Mailing Address - Street 1:PO BOX 3000
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-9000
Mailing Address - Country:US
Mailing Address - Phone:909-796-0216
Mailing Address - Fax:909-799-6656
Practice Address - Street 1:25271 BARTON RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3013
Practice Address - Country:US
Practice Address - Phone:909-796-0216
Practice Address - Fax:909-799-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000146314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA240000146OtherSTATE LICENSE NUMBER
CAZZT05183FMedicaid
CAZZT05183FMedicaid
CA0568420001Medicare NSC