Heritage Manor - Walnut, LLC
Organization Active NPI Oxygen Equipment & Supplies (DME) · Walnut, IL
NPI 1417201963 · NPPES record last updated Oct 18, 2016
Key facts
- NPI
- 1417201963
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Oxygen Equipment & Supplies (DME) 332BX2000X
- Legal business name
- HERITAGE MANOR - WALNUT, LLC
- Practice address
- 308 S 2ND St
Walnut, IL 61376-9364 - Phone
- (815) 379-2131
- Fax
- (815) 379-2235
- NPI assigned
- Nov 6, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- HERITAGE ENTERPRISES, INC
Authorized official
- Name
- David Underwood, CPA
- Title
- Exec VP, Cfo
- Phone
- (309) 823-7135
National Provider Directory
- Part of
- Heritage Enterprises Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oxygen Equipment & Supplies (DME) | 332BX2000X | Yes |
Addresses
Primary practice location
308 S 2ND St
Walnut, IL 61376-9364
Mailing address
115 W Jefferson St
Suite 401
Bloomington, IL 61701-3946
Phone (309) 828-4361
Other names
- Heritage Health
Other providers in Walnut, IL
- Dean a. Hulsing PC
- Katie C Edwards
- Daniel B Fuertges
- Carolyn Jean Gale
- Linda L Grant
- Heritage Manor - Walnut, LLC
- Dean A Hulsing
- Colton Ronald Johnson
- Julia Rackley Perry Memorial Hospital
- Julia Rackley Perry Memorial Hospital
All providers in Walnut, IL · Oxygen Equipment & Supplies (DME) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.