Heritage Manor - Streator

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

Legal business name

HERITAGE MANOR - STREATOR

Practice address

1525 E Main St
Streator, IL 61364-3162

Phone

(815) 672-4516

Fax

(815) 672-5466

NPI assigned

Nov 19, 2012

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

David M Underwood, CPA

Title

Sr VP & Cfo

Phone

(309) 823-7135

Specialties & licenses 1

Addresses

Other names 1

• Heritage Health - Streator Doing business as

Part of

Heritage Enterprises Inc

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

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398297600000",
    "number": "1104160886",
    "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": "309-829-5477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 E MAIN ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613643162",
            "telephone_number": "815-672-4516",
            "fax_number": "815-672-5466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR - STREATOR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE ENTERPRISES, INC",
        "enumeration_date": "2012-11-19",
        "last_updated": "2014-04-24",
        "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": "309-823-7135",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Health - Streator",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jolene R Hancock, PT
• Robert Henry Harms, DVM
• Jessica L Hartman, APN-C
• Meghan Hatzer
• Healing Hands Resource Center Streator
• Heritage Manor Streator, LLC
• Herwig Chiropractic LTD
• William Curtis Herwig, DC
• Patricia A Hess, NP
• Jodi Hiltabrand, CCC-SLP/L

• All providers in Streator, IL
• Oxygen Equipment & Supplies (DME) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2014; 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.