Organization
HERITAGE MANOR - MT. ZION, L.L.C.
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
MR. DAVID M UNDERWOOD CPA (EXEC VP & CFO)
(309) 823-7135
Entity
Organization
Contact information
Practice address
1225 WOODLAND DR, MT ZION, IL 62549-1237
(217) 864-2356
(217) 864-4960
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
—
37-0909086818
PRIOR MEDICAID OXYGEN PROVIDER #
IL
Enumeration date
10/29/2008
Last updated
11/29/2016
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