Heritage Park Nursing and Rehabilitation Center

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5756 Issued in OH

Legal business name

HERITAGE PARK NURSING AND REHABILITATION CENTER

Practice address

3071 N Elyria Rd
Wooster, OH 44691-9379

Phone

(330) 264-2446

Fax

(330) 264-5770

NPI assigned

Feb 17, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Timothy Woodrow Shackleford, NHA

Title

Administrator

Phone

(330) 264-2446

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497729115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3071 N ELYRIA RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446919379",
            "telephone_number": "330-264-2446",
            "fax_number": "330-264-5770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3071 N ELYRIA RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446919379",
            "telephone_number": "330-264-2446",
            "fax_number": "330-264-5770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE PARK NURSING AND REHABILITATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHACKLEFORD",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "WOODROW",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "330-264-2446",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "5756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2146770",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lilly Elizabeth Henney
• Michael S Henry, QMHS
• Tiesha N Henry, QMHS
• Valerie B Henry
• Hallie Henson
• Eunice M Herman, OTR/L
• Karabella Rose Hernandez
• Miguel Hernandez
• Shaianne L Herrera, BSW
• David Hershberger, QMHS

• Skilled Nursing Facility in Wooster, OH
• Providers in Wooster, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.