NPIMap

Organization Active NPI

Heritage Manor - Beardstown East, L.L.C.

  • Skilled Nursing Facility
  • Beardstown, IL
National Provider Identifier
1700877693
Registry record updated Jun 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
048835 Issued in IL
Legal business name
HERITAGE MANOR - BEARDSTOWN EAST, L.L.C.
Practice address
1501 Canal St
Beardstown, IL 62618-2349
Phone
(217) 323-1900
Fax
(217) 323-1914
NPI assigned
Oct 31, 2005
Last updated
Jun 23, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Craig L Ater
Title
Exec. VP & Cfo
Phone
(309) 828-4361

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 048835 IL Primary
Oxygen Equipment & Supplies (DME) 332BX2000X 0048835 IL

Addresses

Primary practice location

1501 Canal St
Beardstown, IL 62618-2349

Mailing address

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

Other names 1

  • Heritage Enterprises, Inc. dba Heritage Manor East - Beardstown Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Heritage Enterprises Inc13 organizations share this tax ID, including this one

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": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340409600000",
    "number": "1700877693",
    "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": "1501 CANAL ST",
            "city": "BEARDSTOWN",
            "state": "IL",
            "postal_code": "626182349",
            "telephone_number": "217-323-1900",
            "fax_number": "217-323-1914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR - BEARDSTOWN EAST, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2012-06-23",
        "status": "A",
        "authorized_official_last_name": "ATER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "L",
        "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": "048835",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IL",
            "license": "0048835",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Enterprises, Inc. dba Heritage Manor East - Beardstown",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Beardstown, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2012; 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.