Organization
HERITAGE MANOR - EL PASO, LLC
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
DAVID UNDERWOOD CPA (EXEC VP, CFO)
(309) 823-7135
Entity
Organization
Contact information
Practice address
555 E CLAY ST, EL PASO, IL 61738-1508
(309) 527-6240
(309) 527-6243
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
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Enumeration date
11/19/2012
Last updated
10/18/2016
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