Organization Name: | HERITAGE MANOR - ROBINSON, LLC |
NPI Number: | 1376534859 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID M UNDERWOOD (SR. VP & CFO) |
Mailing Address: | 600 E Robinwood Drive Robinson |
State: | IL US |
Postal Code: | 624543220 |
Phone Number: | 6185443192 |
Fax Number: | 6185447643 |
NPI Enumeration Date: | 11/02/2005 |
NPI Last Update Date: | 06/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BX2000X |
License Number: | 045138 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Oxygen Equipment & Supplies |
Taxonomy Definition: |