Heritage Manor - Peru, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

48090 Issued in IL

Legal business name

HERITAGE MANOR - PERU, LLC

Doing business as

Heritage Health - Peru

Practice address

1301 21St St
Peru, IL 61354-1359

Phone

(815) 223-4901

Fax

(815) 223-6912

NPI assigned

Oct 28, 2005

Last updated

Apr 18, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

HERITAGE ENTERPRISES, INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David M Underwood

Title

Sr. VP & Cfo

Phone

(309) 828-4361

Specialties & licenses 2

Addresses

Other names 1

• Heritage Health - Peru Doing business as

Part of

Heritage Enterprises Inc

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650240000000",
    "number": "1013907138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W JEFFERSON ST",
            "address_2": "SUITE 401",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013946",
            "telephone_number": "309-828-4361",
            "fax_number": "309-829-9512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 21ST ST",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613541359",
            "telephone_number": "815-223-4901",
            "fax_number": "815-223-6912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR - PERU, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE ENTERPRISES, INC",
        "enumeration_date": "2005-10-28",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR. VP & CFO",
        "authorized_official_telephone_number": "309-828-4361",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "48090",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IL",
            "license": "0048090",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Health - Peru",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heritage Health - Peru",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hanger Prosthetics & Orthotics, Inc (Hanger Clinic)
• Krystal C Hanson
• Diane Marie Harrod, PHARMACIST
• Health and Safety International, Inc
• Mark Alan Henry, DDS MS
• Heritage Manor - Peru, LLC (Heritage Health)
• Kendra Renee Herman, PT, ATC
• Debra Herz, FNP-BC
• Andrea Elizabeth Heslet
• Highland Park CVS LLC (CVS Pharmacy #08655)

• Skilled Nursing Facility in Peru, IL
• Providers in Peru, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.