Wawona Home

LBN: Heritage Estates, Inc.
Wawona Home is an health care organization with primary practice located at 304 Wawona St , Manteca CA 95337-6819. The organization recently has only one registered license in Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as the primary health care specialty. Heritage Estates, Inc. can be contacted via phone (209) 823-6061, or through Perry, Mary A via phone (209) 823-6061.

Contact Information

Primary practice address
304 Wawona St Manteca CA 95337-6819
Phone: (209) 823-6061
Fax: (209) 239-6306
Website:
Map and Directions
Authorized official contact:
Name: Perry, Mary A
Phone: (209) 823-6061

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320900000X 030000412 California

Profile Details

NPI number 1356536965
LBN Legal business name Heritage Estates, Inc.
DBA Doing business as Wawona Home
Authorized official Perry, Mary A
Entity Organization
Organization subpart 1 Yes
Enumeration date Sep 7th, 2007
Last updated Jun 16th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356536965 NPPES
California Other 6034823 MEDI-CAL PIN

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