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Heritage Manor Carlinville, LLC

Organization Active NPI Skilled Nursing Facility · Carlinville, IL

NPI 1831180892 · NPPES record last updated May 27, 2014

Key facts

NPI
1831180892
Entity type
Organization (NPI type 2)
Primary specialty
Skilled Nursing Facility 314000000X
License
048850 (IL)
Legal business name
HERITAGE MANOR CARLINVILLE, LLC
Practice address
1200 University Ave.
Carlinville, IL 62626-9600
Phone
(217) 854-4433
Fax
(217) 854-6291
NPI assigned
Oct 31, 2005
Organization subpart
Yes
Parent organization (as reported)
HERITAGE ENTERPRISES, INC

Authorized official

Name
Mr. David M Underwood
Title
Sr. VP & Cfo
Phone
(309) 828-4361

Corporate family (same tax ID) 12

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Heritage Enterprises Inc (13 organizations share this tax ID)
Part of
Heritage Enterprises Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 048850 IL Yes
Oxygen Equipment & Supplies (DME) 332BX2000X 0048850 IL

Addresses

Primary practice location

1200 University Ave.
Carlinville, IL 62626-9600

Mailing address

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

Other names

  • Heritage Health - Carlinville Doing business as

Other providers in Carlinville, IL

All providers in Carlinville, IL · Skilled Nursing Facility in Illinois

Sources for this page

Verify at the official NPI Registry.