Heritage Enterprises, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

-61702-17 Issued in IL

Legal business name

HERITAGE ENTERPRISES, INC.

Doing business as

Heritage Enterprises, Inc. dba Green Tree Therapy

Practice address

700 E Walnut St
Bloomington, IL 61701-3244

Phone

(309) 829-1268

Fax

(309) 829-3475

NPI assigned

Nov 2, 2005

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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) 828-4361

Specialties & licenses 1

Addresses

Other names 1

• Heritage Enterprises, Inc. dba Green Tree Therapy Doing business as

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1780675488",
    "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": "700 E WALNUT ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013244",
            "telephone_number": "309-829-1268",
            "fax_number": "309-829-3475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE ENTERPRISES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2022-07-21",
        "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": "309-828-4361",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "-61702-17",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Enterprises, Inc. dba Green Tree Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Anne Helton, PHARMD
• Beau Hendren-Santiago
• Drew Henneberg
• Jennifer Henneberg
• Heritage Enterprises, Inc (Green Tree Therapy)
• Heritage Manor - Bloomington, LLC (Heritage Health)
• Heritage Manor - Lasalle, LLC (Heritage Health)
• Heritage Manor Bloomington, LLC (Heritage Health - Bloomington)
• Christopher M Herman, MD
• Robert J Hermann, D.C.

• Physical Therapist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Physical Therapist in Illinois

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