Heritage Manor Normal, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0038281 Issued in IL

Legal business name

HERITAGE MANOR NORMAL, LLC

Practice address

509 N Adelaide St
Normal, IL 61761-2422

Phone

(309) 452-7468

Fax

(309) 862-3148

NPI assigned

Oct 28, 2005

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. VP & Cfo

Phone

(309) 823-7135

Specialties & licenses 2

Addresses

Other names 1

• Heritage Health - Normal Doing business as

Part of

Heritage Enterprises Inc

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406073600000",
    "number": "1841281979",
    "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": "309-823-7135",
            "fax_number": "309-829-5477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 N ADELAIDE ST",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612422",
            "telephone_number": "309-452-7468",
            "fax_number": "309-862-3148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR NORMAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE ENTERPRISES, INC",
        "enumeration_date": "2005-10-28",
        "last_updated": "2014-07-23",
        "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": "309-823-7135",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0038281",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IL",
            "license": "0048082",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Health - Normal",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Hendrix, PA-C
• Lori Ann Henehan, LPC
• Jill Henry, CRNA
• Hannah Herald
• Heritage Manor - Normal
• Amie Kristine Hernandez, APN/CNM
• Shannon Herrera
• Karen Herzel
• Sarah Fraser Hickman
• Highland Park CVS, L.L.C.

• Skilled Nursing Facility in Normal, IL
• Providers in Normal, 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 Jul 23, 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.