| Organization Name: | HERITAGE MANOR - BEARDSTOWN SOUTH, LLC |
| NPI Number: | 1598009128 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID UNDERWOOD (EXEC VP, CFO) |
| Mailing Address: | 8306 Saint Lukes Dr Beardstown |
| State: | IL US |
| Postal Code: | 626188384 |
| Phone Number: | 2173234055 |
| Fax Number: | 2173239454 |
| NPI Enumeration Date: | 11/20/2012 |
| NPI Last Update Date: | 03/24/2016 |
| 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: | |