Organization
HERITAGE MANOR STREATOR, LLC
Active
Parent organization
HERITAGE ENTERPRISES, INC
Other names
Heritage Health - Streator
Organization subpart
Yes
Provider details
NPI number
Legal business name
HERITAGE ENTERPRISES, INC
Authorized official
MR. DAVID M UNDERWOOD (SR. VP & CFO)
(309) 828-4361
Entity
Organization
Contact information
Practice address
1525 E MAIN ST, STREATOR, IL 61364-3162
(815) 672-4516
(815) 672-5466
Mailing address
115 W JEFFERSON ST, SUITE 401, BLOOMINGTON, IL 61701-3946
(309) 828-4361
(309) 829-9512
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
IL
2251G0304X
Geriatric Physical Therapist
—
IL
225200000X
Physical Therapy Assistant
—
IL
225XP0019X
Physical Rehabilitation Occupational Therapist
—
IL
235Z00000X
Speech-Language Pathologist
—
IL
314000000X
Skilled Nursing Facility
Primary
48066
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
48066
IL
Other
Enumeration date
10/28/2005
Last updated
05/27/2014
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