Provider Demographics
NPI:1942196811
Name:HERITAGE HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:HERITAGE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ONYEBUCHI
Authorized Official - Middle Name:
Authorized Official - Last Name:UKAEJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-868-4509
Mailing Address - Street 1:6200 BALTIMORE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1054
Mailing Address - Country:US
Mailing Address - Phone:301-613-2064
Mailing Address - Fax:
Practice Address - Street 1:6200 BALTIMORE AVE STE 300
Practice Address - Street 2:
Practice Address - City:RIVERDALE PARK
Practice Address - State:MD
Practice Address - Zip Code:20737-1054
Practice Address - Country:US
Practice Address - Phone:312-868-4509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251J00000XAgenciesNursing Care