Organization
HERITAGE MANOR MINONK, LLC
Active
Parent organization
HERITAGE ENTERPRISES, INC
Other names
Heritage Health - Minonk
Organization subpart
Yes
Provider details
NPI number
Legal business name
HERITAGE ENTERPRISES, INC
Authorized official
MR. DAVID M UNDERWOOD (SR. V.P. & CFO)
(309) 823-7135
Entity
Organization
Contact information
Practice address
201 LOCUST ST, MINONK, IL 61760-1511
(309) 432-2557
(309) 432-3330
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
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
48058
IL
Other
Enumeration date
10/28/2005
Last updated
06/12/2014
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