| Organization Name: | HERITAGE MANOR - COLFAX, LLC |
| NPI Number: | 1205827268 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CRAIG L ATER (EXEC. VP & CFO) |
| Mailing Address: | 402 S Harrison St R.r. 2, Box 56 Colfax |
| State: | IL US |
| Postal Code: | 617287536 |
| Phone Number: | 3097232591 |
| Fax Number: | 3097233013 |
| NPI Enumeration Date: | 10/31/2005 |
| NPI Last Update Date: | 09/11/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | 0048140 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |