Provider Demographics
NPI:1679794002
Name:HERITAGE HIGH ASSISTED LIVING CENTER
Entity type:Organization
Organization Name:HERITAGE HIGH ASSISTED LIVING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-256-1525
Mailing Address - Street 1:211 NW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-2884
Mailing Address - Country:US
Mailing Address - Phone:605-256-1525
Mailing Address - Fax:605-256-1535
Practice Address - Street 1:211 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-2884
Practice Address - Country:US
Practice Address - Phone:605-256-1525
Practice Address - Fax:605-256-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD45936310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9570340Medicaid