Heritage Estates, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

030000295 Issued in CA

Legal business name

HERITAGE ESTATES, INC.

Doing business as

Tahoe Home

Practice address

790 Tahoe St
Manteca, CA 95337-6817

Phone

(209) 823-6061

Fax

(209) 239-6306

NPI assigned

Sep 7, 2007

Last updated

Jun 16, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

HERITAGE ESTATES INCAs reported in NPPES

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

Authorized official

Name

Ms. Mary A Perry

Title

Secretary/Treasurer

Phone

(209) 823-6061

Specialties & licenses 1

Addresses

Other names 1

• TAHOE HOME Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629263231. Details of each certification follow.

• CCN 05G224 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 05G224

Legal name

Tahoe Home

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Sep 4, 1986

Last certification

Jul 9, 2025

Beds

6

Ownership / control type

Private (proprietary)

Facility address

790 Tahoe Street
Manteca, CA 95337

Tax ID family

Heritage Estates Inc5 organizations share this tax ID, including this one

Part of

Heritage Estates Inc

Other organizations with this tax ID 4

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

• Heritage Estates, Inc.

  dba Sunny Road Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Stockton, CA
  • NPI 1083808018
  NPD tax ID
• Heritage Estates, Inc.

  dba Navajo Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Manteca, CA
  • NPI 1356535389
  NPD tax ID
• Heritage Estates, Inc.

  dba Wawona Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Manteca, CA
  • NPI 1356536965
  NPD tax ID
• Heritage Estates, Inc.

  dba Locust Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Manteca, CA
  • NPI 1710171749
  NPD tax ID

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1629263231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 293",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953361124",
            "telephone_number": "209-823-6061",
            "fax_number": "209-239-6306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 TAHOE ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953376817",
            "telephone_number": "209-823-6061",
            "fax_number": "209-239-6306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE ESTATES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE ESTATES INC",
        "enumeration_date": "2007-09-07",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "209-823-6061",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "030000295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TAHOE HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Danielle Hendricks
• Henry Pallotta & Caramia Pallotta, PTRS (Manteca Physical Therapy)
• Sarah J Heringer, DO
• Heritage Estates, Inc. (Navajo Home)
• Heritage Estates, Inc. (Wawona Home)
• Heritage Estates, Inc. (Locust Home)
• Alicia Hernandez
• Natalia Guadalupe Hernandez
• Dayanara Herrera
• Verenice Herrera

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Manteca, CA
• Providers in Manteca, CA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.