Organization
HERITAGE MANOR - MENDOTA, LLC
Active
Parent organization
HERITAGE ENTERPRISES, INC
Other names
Heritage Health - Mendota
Organization subpart
Yes
Provider details
NPI number
Legal business name
HERITAGE ENTERPRISES, INC
Authorized official
DAVID M UNDERWOOD CPA (SR. VP, CFO)
(309) 823-7135
Entity
Organization
Contact information
Practice address
1201 1ST AVE, MENDOTA, IL 61342-1815
(815) 539-6745
(815) 538-2017
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
04/24/2014
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