Heritage Manor Elgin, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

48132 Issued in IL

Legal business name

HERITAGE MANOR ELGIN, LLC

Doing business as

Heritage Health - Elgin

Practice address

355 Raymond St
Elgin, IL 60120-7875

Phone

(847) 697-6636

Fax

(547) 742-6151

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) 828-4361

Specialties & licenses 2

Addresses

Other names 1

• Heritage Health - Elgin 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": "1401148800000",
    "number": "1871583955",
    "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": "355 RAYMOND ST",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601207875",
            "telephone_number": "847-697-6636",
            "fax_number": "547-742-6151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR ELGIN, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE ENTERPRISES, INC",
        "enumeration_date": "2005-10-28",
        "last_updated": "2014-05-27",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "48132",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IL",
            "license": "0048132",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Health - Elgin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer R Hensley, MD
• Taylor Rose Herbord
• Arnold J Herbstman, M.D.
• Monica Rose Herdrich, FNP-C
• Heritage Manor - Elgin, LLC
• Heritage Primary Care, S.C.
• Kayla Herman
• Vanessa Hermosillo, LPC
• Antonio E Hernandez-Silva, PMHNP
• Abbie Lauren Hernandez

• Skilled Nursing Facility in Elgin, IL
• Providers in Elgin, 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 May 27, 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.