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Organization
HERITAGE MANOR - CARLINVILLE, L.L.C.
Active
Organization
HERITAGE MANOR - CARLINVILLE, L.L.C.
Active
Parent organization
HERITAGE ENTERPRISES, INC.
Other names
Heritage Enterprises, Inc dba Heritage Manor Carlinville
Organization subpart
Yes
Provider details
NPI number
Legal business name
HERITAGE ENTERPRISES, INC.
Authorized official
MR. CRAIG L. ATER (SENIOR VICE PRESIDENT OF FINANCE)
(309) 828-4361
Entity
Organization
Contact information
Practice address
1200 UNIVERSITY AVENUE, CARLINVILLE, IL 62626-9600
(217) 854-4433
(217) 854-6291
Mailing address
115 W JEFFERSON ST, STE 401, BLOOMINGTON, IL 61701-3946
(309) 828-4361
(309) 829-9512
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370909086806
PRIOR MEDICAID OXYGEN PROVIDER #
IL
Enumeration date
09/22/2008
Last updated
02/04/2009
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