Heritage Life Center LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

HERITAGE LIFE CENTER LLC

Doing business as

Heritage Lane Behavioral Assisted Living

Practice address

1040 S Lebaron
Mesa, AZ 85210-3631

Phone

(480) 307-8809

Fax

(480) 781-0019

NPI assigned

Jan 7, 2011

Last updated

May 5, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Reed T Gunnell

Title

Owner

Phone

(480) 307-8809

Specialties & licenses 2

Addresses

Other names 1

• Heritage Lane Behavioral Assisted Living Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Heritage Lane Behavioral Assisted Living2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Heritage Life Center LLC

  dba Heritage Lane Behavioral Assisted Living

  • Assisted Living Facility (Mental Illness)
  • Mesa, AZ
  • NPI 1144452988
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651708800000",
    "number": "1053615906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 S LEBARON",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103631",
            "telephone_number": "480-307-8809",
            "fax_number": "480-307-8803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 S LEBARON",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103631",
            "telephone_number": "480-307-8809",
            "fax_number": "480-781-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE LIFE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-07",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A",
        "authorized_official_last_name": "GUNNELL",
        "authorized_official_first_name": "REED",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-307-8809",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AL7718C",
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Lane Behavioral Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Monika Anna Herdzik, MD
• Darla Hergenroether
• Michael Anthony Herion, M.D.
• Heritage Academy Gateway, Inc.
• Heritage Academy, Inc.
• Heritage Life Center LLC (Heritage Lane Behavioral Assisted Living)
• Heritage Spinal Care LLC
• Heritage Technologies, LLC (Desert Grove Family Medical)
• Heritage Village 3 LLC
• Heritage Village 5 LLC

• Assisted Living Facility (Mental Illness) in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Assisted Living Facility (Mental Illness) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.