| Organization Name: | HERITAGE MANOR GIBSON CITY, LLC |
| NPI Number: | 1699765719 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID M UNDERWOOD (EXEC VP & CFO) |
| Mailing Address: | 620 E 1st St Gibson City |
| State: | IL US |
| Postal Code: | 609361822 |
| Phone Number: | 2177844257 |
| Fax Number: | 2177848279 |
| NPI Enumeration Date: | 10/28/2005 |
| NPI Last Update Date: | 03/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | 0048116 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |