NPIMap

Organization Active NPI

Heritage Manor Pana, LLC

  • Skilled Nursing Facility
  • Pana, IL
National Provider Identifier
1104817816
Registry record updated May 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0048884 Issued in IL
Legal business name
HERITAGE MANOR PANA, LLC
Practice address
1000 E 6TH St
Pana, IL 62557-1870
Phone
(217) 562-2174
Fax
(217) 562-7242
NPI assigned
Nov 2, 2005
Organization subpart
Yes
Parent organization
HERITAGE ENTERPRISES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 27, 2014

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 0048884 IL Primary
Oxygen Equipment & Supplies (DME) 332BX2000X 0048884 IL

Addresses

Primary practice location

1000 E 6TH St
Pana, IL 62557-1870

Mailing address

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

Other names 1

  • Heritage Health - Pana 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": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401148800000",
    "number": "1104817816",
    "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": "1000 E 6TH ST",
            "city": "PANA",
            "state": "IL",
            "postal_code": "625571870",
            "telephone_number": "217-562-2174",
            "fax_number": "217-562-7242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR PANA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE ENTERPRISES, INC",
        "enumeration_date": "2005-11-02",
        "last_updated": "2014-05-27",
        "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": "0048884",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IL",
            "license": "0048884",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Health - Pana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pana, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.