Heritage Grove

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH1291 Issued in WA

Legal business name

HERITAGE GROVE

Practice address

115 N 10TH St
Yakima, WA 98901-2572

Phone

(509) 248-4173

Fax

(509) 249-6246

NPI assigned

Sep 7, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Kylle Fish, M.A.

Title

Administrator

Phone

(509) 248-4173

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740274695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 N 10TH ST",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989012572",
            "telephone_number": "509-248-4173",
            "fax_number": "509-249-6246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N 10TH ST",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989012572",
            "telephone_number": "509-248-4173",
            "fax_number": "509-249-6246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE GROVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FISH",
        "authorized_official_first_name": "KYLLE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "509-248-4173",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "NH1291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4112918",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Yakima, WA
• Providers in Yakima, WA by specialty
• Skilled Nursing Facility in Washington

• 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.