Heritage Manor Minonk, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

48058 Issued in IL

Legal business name

HERITAGE MANOR MINONK, LLC

Doing business as

Heritage Health - Minonk

Practice address

201 Locust St
Minonk, IL 61760-1511

Phone

(309) 432-2557

Fax

(309) 432-3330

NPI assigned

Oct 28, 2005

Last updated

Jun 12, 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. V.P. & Cfo

Phone

(309) 823-7135

Specialties & licenses 6

Addresses

Other names 1

• Heritage Health - Minonk Doing business as

Part of

Heritage Enterprises Inc

Locations

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402531200000",
    "number": "1750372801",
    "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": "201 LOCUST ST",
            "city": "MINONK",
            "state": "IL",
            "postal_code": "617601511",
            "telephone_number": "309-432-2557",
            "fax_number": "309-432-3330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR MINONK, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE ENTERPRISES, INC",
        "enumeration_date": "2005-10-28",
        "last_updated": "2014-06-12",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR. V.P. & CFO",
        "authorized_official_telephone_number": "309-823-7135",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "48058",
            "primary": true
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Health - Minonk",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeremy Gray, PHARMD.
• Green Tree Pharmacy, Inc. (Green Tree Pharmacy)
• Jamie Harrison, PHARMD
• Neil Paul Heineke, PHARM D.
• Heritage Manor - Minonk, LLC (Heritage Health)
• Mayla M Jenkins, CPHT
• Joseph Lutterbie, PHARMD
• Amy Naas
• Darcie Omiotek, SLP
• John E Podzamsky, DO

• Skilled Nursing Facility in Minonk, IL
• Providers in Minonk, 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 Jun 12, 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.