Organization Name: | HERITAGE MANOR - CARLINVILLE, L.L.C. |
NPI Number: | 1477703882 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CRAIG L. ATER (SENIOR VICE PRESIDENT OF FINANCE) |
Mailing Address: | 1200 University Avenue Carlinville |
State: | IL US |
Postal Code: | 626269600 |
Phone Number: | 2178544433 |
Fax Number: | 2178546291 |
NPI Enumeration Date: | 09/22/2008 |
NPI Last Update Date: | 02/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BX2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Oxygen Equipment & Supplies |
Taxonomy Definition: |