| Organization Name: | HERITAGE MANOR - STREATOR |
| NPI Number: | 1104160886 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID M UNDERWOOD (SR VP & CFO) |
| Mailing Address: | 1525 E Main St Streator |
| State: | IL US |
| Postal Code: | 613643162 |
| Phone Number: | 8156724516 |
| Fax Number: | 8156725466 |
| NPI Enumeration Date: | 11/19/2012 |
| NPI Last Update Date: | 04/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |