HERITAGE MANOR - MENDOTA LLC NPI 1982948683

NPI Information

NPI: 1982948683
Provider Name: HERITAGE MANOR - MENDOTA, LLC

Doing Business As: HERITAGE HEALTH - MENDOTA

Classification: Durable Medical Equipment & Medical Supplies - 332BX2000X
Entity Type: Organization

Specialization: Oxygen Equipment & Supplies

Address:
1201 1ST AVE
MENDOTA, IL
ZIP 61342
Phone: (815) 539-6745
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HERITAGE MANOR - MENDOTA, LLC is an oxygen equipment and supplies durable medical equipment medical supplies in Mendota, IL. HERITAGE MANOR - MENDOTA, LLC NPI is 1982948683. The provider is registered as an organization entity type.
The provider Is Doing Business As Heritage Health - Mendota.

The provider's business location address is:

1201 1ST AVE
MENDOTA, IL
ZIP 61342-815
Phone: (815) 539-6745
Fax: (815) 538-2017

The provider's authorized official is David M Underwood .
The authorized official title is Sr. Vp, Cfo and has the following contact phone number (309) 823-7135.

The CLIA number assigned to this NPI record is 14D0672641 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/19/2012 and was last updated on 4/24/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332BX2000X	Durable Medical Equipment & Medical Supplies	Oxygen Equipment & Supplies			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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