Organization
HERITAGE MANOR - LASALLE, LLC
Active
Parent organization
HERITAGE ENTERPRISES, INC
Other names
Heritage Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
HERITAGE ENTERPRISES, INC
Authorized official
CRAIG L ATER CPA (EXEC VP)
(309) 823-7135
Entity
Organization
Contact information
Practice address
115 W JEFFERSON ST, SUITE 401, BLOOMINGTON, IL 61701-3946
(309) 828-4361
(309) 829-5477
Mailing address
1445 CHARTRES ST, LA SALLE, IL 61301-1508
(815) 223-4700
(815) 223-4708
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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