Organization
HERITAGE MANOR STAUNTON LLC
Active
Parent organization
HERITAGE ENTERPRISES, INC
Other names
Heritage Health - Staunton
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
215 W PENNSYLVANIA ST, STAUNTON, IL 62088-1127
(618) 635-5577
(618) 635-5580
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
0048876
IL
Other
Enumeration date
11/02/2005
Last updated
04/04/2016
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