Heritage Manor Lasalle, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0051276 Issued in IL

Legal business name

HERITAGE MANOR LASALLE, LLC

Doing business as

Heritage Health - LaSalle

Practice address

1445 Chartres St
La Salle, IL 61301-1508

Phone

(815) 223-4700

Fax

(815) 223-4708

NPI assigned

May 11, 2011

Last updated

May 27, 2014By the provider in NPPES

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

Mr. David M Underwood

Title

Sr VP & Cfo

Phone

(309) 823-7135

Specialties & licenses 1

Addresses

Other names 1

• Heritage Health - LaSalle Doing business as

Part of

Heritage Enterprises Inc

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

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401148800000",
    "number": "1679865455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 CHARTRES ST",
            "city": "LA SALLE",
            "state": "IL",
            "postal_code": "613011508",
            "telephone_number": "815-223-4700",
            "fax_number": "815-223-4708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 CHARTRES ST",
            "city": "LA SALLE",
            "state": "IL",
            "postal_code": "613011508",
            "telephone_number": "815-223-4700",
            "fax_number": "815-223-4708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR LASALLE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE ENTERPRISES, INC",
        "enumeration_date": "2011-05-11",
        "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": "309-823-7135",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0051276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Health - LaSalle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Liberty Kathleen Grzybowski, LCSW
• Ronald James Hall, LCSW
• Gary Hammers
• Matthew V Hartman, DMD
• Terri Hastings, LCPC
• Hillmann Pediatric Therapy
• Lauren Elizabeth Holt, LCPC
• Florence Horaney, LCPC
• Debra Kay Hultine, P.T.
• Bayrnadette Humilde

• Skilled Nursing Facility in La Salle, IL
• Providers in La Salle, IL by specialty
• Skilled Nursing Facility in Illinois

• 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.