Organization
HERITAGE MANOR BLOOMINGTON, LLC
Active
Parent organization
HERITAGE ENTERPRISES, INC
Other names
Heritage Health - Bloomington
Organization subpart
Yes
Provider details
NPI number
Legal business name
HERITAGE ENTERPRISES, INC
Authorized official
DAVID M UNDERWOOD (SR. VP & CFO)
(309) 828-4361
Entity
Organization
Contact information
Practice address
700 E WALNUT ST, BLOOMINGTON, IL 61701-3244
(309) 827-8004
(309) 827-0256
Mailing address
115 W JEFFERSON ST, SUITE 401, BLOOMINGTON, IL 61701-3946
(309) 828-4361
(309) 829-5477
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
48157
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
48157
IL
Other
Enumeration date
08/18/2005
Last updated
05/27/2014
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