Basic Information
| Provider Information | |||||||||
| NPI: | 1376782656 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HERITAGE HOUSE NORTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 N STATE COLLEGE BLVD | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928062915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174687007 | ||||||||
| FaxNumber: | 7146870691 | ||||||||
| Practice Location | |||||||||
| Address1: | 321 N STATE COLLEGE BLVD | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928062915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174687007 | ||||||||
| FaxNumber: | 7146870691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 02/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | RUDAR | ||||||||
| AuthorizedOfficialFirstName: | NATASHA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7146870077 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M.A. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 300054IN | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.