NPIMap

Organization Active NPI

Heritage Enterprises, Inc.

Doing business as Evergreen Place Supportive Living Facility

  • Assisted Living Facility
  • Beardstown, IL
National Provider Identifier
1710156609
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
1825445 Issued in IL
Legal business name
HERITAGE ENTERPRISES, INC.
Doing business as
Evergreen Place Supportive Living Facility
Practice address
8570 Saint Lukes Dr
Beardstown, IL 62618-9200
Phone
(217) 323-4055
Fax
(217) 323-9454
NPI assigned
Feb 25, 2008
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
HERITAGE MANOR - BEARDSTOWN SOUTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mr. Craig L Ater
Title
Senior V. P. of Finance
Phone
(309) 823-7135

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 1825445 IL Primary

Addresses

Primary practice location

8570 Saint Lukes Dr
Beardstown, IL 62618-9200

Mailing address

115 W Jefferson St
Suite 401
Bloomington, IL 61701-3946
Phone (309) 823-7155

Other names 1

  • Evergreen Place Supportive Living Facility 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": "1203897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1710156609",
    "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": "309-823-7155",
            "fax_number": "309-829-9512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8570 SAINT LUKES DR",
            "city": "BEARDSTOWN",
            "state": "IL",
            "postal_code": "626189200",
            "telephone_number": "217-323-4055",
            "fax_number": "217-323-9454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE ENTERPRISES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE MANOR - BEARDSTOWN SOUTH",
        "enumeration_date": "2008-02-25",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "ATER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR V. P. OF FINANCE",
        "authorized_official_telephone_number": "309-823-7135",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IL",
            "license": "1825445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Place Supportive Living Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 20, 2008; 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.