Heritage Manor Staunton LLC
Organization Active NPI Skilled Nursing Facility · Staunton, IL
NPI 1629069331 · NPPES record last updated Apr 4, 2016
Key facts
- NPI
- 1629069331
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 0048876 (IL)
- Legal business name
- HERITAGE MANOR STAUNTON LLC
- Practice address
- 215 W Pennsylvania St
Staunton, IL 62088-1127 - Phone
- (618) 635-5577
- Fax
- (618) 635-5580
- NPI assigned
- Nov 2, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- HERITAGE ENTERPRISES, INC
Authorized official
- Name
- Mr. David M Underwood
- Title
- Sr. VP & Cfo
- Phone
- (309) 828-4361
Corporate family (same tax ID) 12
National Provider Directory
- Tax ID family
- Heritage Enterprises Inc
- Part of
- Heritage Enterprises Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 0048876 | IL | Yes |
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
- Heritage Health - Staunton
Other providers in Staunton, IL
- Fritz Drug Store Inc.
- Gahcr II Staunton Alf TRS Sub, LLC
- Amber Marie Geilhausen
- Jennie Gipson
- Heritage Manor - Staunton, LLC
- Highland Park CVS LLC
- Poonam Jain
- Rajneesh Satish Jain
- John B Caldieraro III, DMD, PC
- Alicia Ann Keck
All providers in Staunton, IL · Skilled Nursing Facility in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 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.