Heritage Manor - Gibson City, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

48116 Issued in IL

Legal business name

HERITAGE MANOR - GIBSON CITY, LLC

Doing business as

Heritage Health - Gibson City

Practice address

620 E 1St St
Gibson City, IL 60936-1822

Phone

(217) 784-4257

Fax

(217) 784-8279

NPI assigned

Oct 28, 2005

Last updated

Mar 21, 2022By 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

Exec VP & Cfo

Phone

(309) 828-4361

Specialties & licenses 2

Addresses

Other names 1

• Heritage Health - Gibson City Doing business as

Part of

Heritage Enterprises Inc

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647820800000",
    "number": "1699765719",
    "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": "620 E 1ST ST",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361822",
            "telephone_number": "217-784-4257",
            "fax_number": "217-784-8279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR - GIBSON CITY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE ENTERPRISES, INC",
        "enumeration_date": "2005-10-28",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXEC 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": "48116",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IL",
            "license": "0048116",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Health - Gibson City",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heritage Health - Gibson City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christine Grundeman
• David John Hagan, MD
• Donna Ihsan Hakky, DMD
• Laura Elizabeth Hendrick, MSP, CF-SLP
• Heritage Manor - Gibson City, LLC (Heritage Health)
• Diane Beth Heyman
• Joel G Hirschfeld, MSPT
• Mary Elisabeth Jacobson
• Ajay Jeetwani, MD
• Elizabeth Benita Jennings, INTERPRETER

• Skilled Nursing Facility in Gibson City, IL
• Providers in Gibson City, 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 Mar 21, 2022; 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.