Organization
HERITAGE ESTATES, INC.
Active
Parent organization
HERITAGE ESTATES INC
Other names
LOCUST HOME
Organization subpart
Yes
Provider details
NPI number
Legal business name
HERITAGE ESTATES INC
Authorized official
MS. MARY A PERRY (SECRETARY/TREASURER)
(209) 823-6061
Entity
Organization
Contact information
Practice address
1151 LOCUST AVE, MANTECA, CA 95337-6863
(209) 823-6061
(209) 239-6306
Mailing address
PO BOX 293, MANTECA, CA 95336-1124
(209) 823-6061
(209) 239-6306
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
030000239
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3545713
MEDI-CAL PIN
CA
Enumeration date
09/03/2007
Last updated
06/16/2008
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