Heritage Manor - Bloomington, LLC

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

Legal business name

HERITAGE MANOR - BLOOMINGTON, LLC

Practice address

700 E Walnut St
Bloomington, IL 61701-3244

Phone

(309) 827-8004

Fax

(309) 827-0256

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 Underwood, CPA

Title

Exec VP, Cfo

Phone

(309) 823-7135

Specialties & licenses 1

Addresses

Other names 1

• Heritage Health Doing business as

Part of

Heritage Enterprises Inc

Locations

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

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1275877979",
    "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": "700 E WALNUT ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013244",
            "telephone_number": "309-827-8004",
            "fax_number": "309-827-0256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR - BLOOMINGTON, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE ENTERPRISES, INC",
        "enumeration_date": "2012-11-19",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXEC 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",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Beau Hendren-Santiago
• Drew Henneberg
• Jennifer Henneberg
• Heritage Enterprises, Inc
• Heritage Enterprises, Inc.
• Heritage Manor - Lasalle, LLC
• Heritage Manor Bloomington, LLC
• Christopher M Herman, MD
• Robert J Hermann, D.C.
• Kiran Elizabeth Hermon

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; 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.