NPIMap

Organization Active NPI

Heritage Manor - El Paso, LLC

Doing business as Heritage Health - El Paso

  • Skilled Nursing Facility
  • El Paso, IL
National Provider Identifier
1093706137
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
48124 Issued in IL
Legal business name
HERITAGE MANOR - EL PASO, LLC
Doing business as
Heritage Health - El Paso
Practice address
555 E Clay St
El Paso, IL 61738-1508
Phone
(309) 527-6240
Fax
(309) 527-6243
NPI assigned
Oct 28, 2005
Last updated
Apr 6, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
HERITAGE ENTERPRISES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 48124 IL Primary
Oxygen Equipment & Supplies (DME) 332BX2000X 0048124 IL

Addresses

Primary practice location

555 E Clay St
El Paso, IL 61738-1508

Mailing address

115 W Jefferson St
Suite 401
Bloomington, IL 61701-3946
Phone (309) 828-4361

Other identifiers 1

IdentifierTypeStateIssuer
2039003447-801OtherILMEDICAID OXYGEN PROVIDER

Other names 1

  • Heritage Health - El Paso Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heritage Enterprises Inc13 organizations share this tax ID, including this one
Part of
Heritage Enterprises Inc

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649203200000",
    "number": "1093706137",
    "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": "555 E CLAY ST",
            "city": "EL PASO",
            "state": "IL",
            "postal_code": "617381508",
            "telephone_number": "309-527-6240",
            "fax_number": "309-527-6243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR - EL PASO, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE ENTERPRISES, INC",
        "enumeration_date": "2005-10-28",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "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": "48124",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IL",
            "license": "0048124",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID OXYGEN PROVIDER",
            "identifier": "2039003447-801",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Health - El Paso",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heritage Health - El Paso",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Paso, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.