Organization
HERITAGE MANOR - WALNUT, 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
MR. DAVID M UNDERWOOD (SR. VP & CFO)
(309) 823-7135
Entity
Organization
Contact information
Practice address
308 S 2ND ST, WALNUT, IL 61376-9363
(815) 379-2131
(815) 379-2235
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
314000000X
Skilled Nursing Facility
Primary
0015784
IL
Other
Enumeration date
11/03/2005
Last updated
01/12/2016
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