Provider Demographics
NPI:1821780818
Name:HERITAGE HEALTH SYSTEM LLC
Entity type:Organization
Organization Name:HERITAGE HEALTH SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUNMI
Authorized Official - Middle Name:OLAIDE
Authorized Official - Last Name:OLAWALE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:781-742-0834
Mailing Address - Street 1:450 PROVIDENCE HWY # 1093
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6815
Mailing Address - Country:US
Mailing Address - Phone:781-742-0834
Mailing Address - Fax:
Practice Address - Street 1:21 MAYOR THOMAS J MCGRATH HWY STE 306
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5351
Practice Address - Country:US
Practice Address - Phone:781-742-0834
Practice Address - Fax:781-459-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty