NPIMap

Organization Active NPI

Heritage Healthcare Group LLC

  • Health Service Clinic/Center
  • Chicago, IL
National Provider Identifier
1386995058
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
6 Issued in IL
Legal business name
HERITAGE HEALTHCARE GROUP LLC
Practice address
4356 N Kenmore Ave
Apt 101
Chicago, IL 60613-1330
Phone
(312) 550-3612
NPI assigned
Sep 21, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Andrew Dacy
Title
Executive Director
Phone
(847) 208-7620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 6 IL Primary

Addresses

Primary practice location

4356 N Kenmore Ave
Apt 101
Chicago, IL 60613-1330

Mailing address

316 N Milwaukee St
Suite 208
Milwaukee, WI 53202-5885
Phone (888) 348-6773

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1348185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1386995058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 N MILWAUKEE ST",
            "address_2": "SUITE 208",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532025885",
            "telephone_number": "888-348-6773",
            "fax_number": "888-389-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4356 N KENMORE AVE",
            "address_2": "APT 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606131330",
            "telephone_number": "312-550-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE HEALTHCARE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-21",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DACY",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "847-208-7620"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "IL",
            "license": "6",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.