Basic Information
| Provider Information | |||||||||
| NPI: | 1942553573 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HERITAGE PLACE MANAGEMENT LLC | ||||||||
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| OtherOrganizationName: | HERITAGE PLACE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 SW 1ST AVE | ||||||||
| Address2: | # 180 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972015362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036841123 | ||||||||
| FaxNumber: | 5036842533 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BOUNTIFUL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840106351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012983241 | ||||||||
| FaxNumber: | 8012983265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2012 | ||||||||
| LastUpdateDate: | 10/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO, PRESIDENT & SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 2124784117 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.