Organization
HERITAGE MANOR NORMAL, LLC
Active
Parent organization
HERITAGE ENTERPRISES, INC
Other names
Heritage Health - Normal
Organization subpart
Yes
Provider details
NPI number
Legal business name
HERITAGE ENTERPRISES, INC
Authorized official
MR. DAVID M UNDERWOOD (SR. VP & CFO)
(309) 823-7135
Entity
Organization
Contact information
Practice address
509 N ADELAIDE ST, NORMAL, IL 61761-2422
(309) 452-7468
(309) 862-3148
Mailing address
115 W JEFFERSON ST, SUITE 401, BLOOMINGTON, IL 61701-3946
(309) 823-7135
(309) 829-5477
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0038281
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
0048082
IL
Other
Enumeration date
10/28/2005
Last updated
07/23/2014
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