Provider Demographics
NPI:1548712474
Name:HERITAGE HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:HERITAGE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LENSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-757-0422
Mailing Address - Street 1:860 BLUE GENTIAN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1567
Mailing Address - Country:US
Mailing Address - Phone:651-757-0422
Mailing Address - Fax:651-846-5760
Practice Address - Street 1:860 BLUE GENTIAN RD STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1567
Practice Address - Country:US
Practice Address - Phone:651-757-0422
Practice Address - Fax:651-846-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care