Provider Demographics
NPI:1902595671
Name:HERITAGE CARE HOME OF TAYLORSVILLE
Entity Type:Organization
Organization Name:HERITAGE CARE HOME OF TAYLORSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-593-8766
Mailing Address - Street 1:42020 VILLAGE CENTER PLAZA STE 120-176
Mailing Address - Street 2:
Mailing Address - City:STONERIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:20105
Mailing Address - Country:US
Mailing Address - Phone:855-593-8766
Mailing Address - Fax:
Practice Address - Street 1:668 WOOD ROAD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681
Practice Address - Country:US
Practice Address - Phone:855-593-8766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home