Provider Demographics
NPI:1700077443
Name:HERITAGE CHRISTIAN SERVICES INC
Entity type:Organization
Organization Name:HERITAGE CHRISTIAN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEITNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-340-2000
Mailing Address - Street 1:349 WEST COMMERCIAL STREET
Mailing Address - Street 2:SUITE 2795
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445
Mailing Address - Country:US
Mailing Address - Phone:585-340-2000
Mailing Address - Fax:585-340-2006
Practice Address - Street 1:349 WEST COMMERCIAL STREET
Practice Address - Street 2:SUITE 2795
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445
Practice Address - Country:US
Practice Address - Phone:585-340-2000
Practice Address - Fax:585-340-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1901L001251E00000X
320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01960663Medicaid
NY01750650Medicaid
NY02587300Medicaid
NY01522623Medicaid
NY01999499Medicaid
NY02119244Medicaid
NY02532841Medicaid
NY01984918Medicaid
NY02171153Medicaid
NY02463207Medicaid
NY02610997Medicaid
NY01855852Medicaid
NY02594301Medicaid
NY02594310Medicaid
NY01999366Medicaid
NY02247276Medicaid
NY02266888Medicaid
NY02416228Medicaid
NY02557959Medicaid
NY02596110Medicaid