Organization
HERITAGE MANOR BEARDSTOWN SOUTH, LLC
Active
Parent organization
HERITAGE ENTERPRISES, INC
Other names
Heritage Health - Beardstown
Organization subpart
Yes
Provider details
NPI number
Legal business name
HERITAGE ENTERPRISES, INC
Authorized official
MR. DAVID M UNDERWOOD (SR. VICE PRESIDENT & CFO)
(309) 828-4361
Entity
Organization
Contact information
Practice address
8306 SAINT LUKES DR, BEARDSTOWN, IL 62618-8384
(217) 323-4055
(217) 323-9454
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
314000000X
Skilled Nursing Facility
Primary
48843
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
0048843
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205300208-001
—
IL
01
—
205300208-801
MEDICAID OXYGEN PROVIDER NUMBER
IL
Enumeration date
10/31/2005
Last updated
05/27/2014
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