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Organization Active NPI

Heritage Manor Staunton LLC

Doing business as Heritage Health - Staunton

  • Skilled Nursing Facility
  • Staunton, IL
National Provider Identifier
1629069331
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0048876 Issued in IL
Legal business name
HERITAGE MANOR STAUNTON LLC
Doing business as
Heritage Health - Staunton
Practice address
215 W Pennsylvania St
Staunton, IL 62088-1127
Phone
(618) 635-5577
Fax
(618) 635-5580
NPI assigned
Nov 2, 2005
Last updated
Apr 4, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
HERITAGE ENTERPRISES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0048876 IL Primary

Addresses

Primary practice location

215 W Pennsylvania St
Staunton, IL 62088-1127

Mailing address

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

Other names 1

  • Heritage Health - Staunton 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": "1459728000000",
    "number": "1629069331",
    "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": "215 W PENNSYLVANIA ST",
            "city": "STAUNTON",
            "state": "IL",
            "postal_code": "620881127",
            "telephone_number": "618-635-5577",
            "fax_number": "618-635-5580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR STAUNTON LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE ENTERPRISES, INC",
        "enumeration_date": "2005-11-02",
        "last_updated": "2016-04-04",
        "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": "0048876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Health - Staunton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Staunton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.