Organization Name: | HERITAGE MANOR - BEARDSTOWN EAST, L.L.C. |
NPI Number: | 1700877693 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CRAIG L ATER (EXEC. VP & CFO) |
Mailing Address: | 1501 Canal St Beardstown |
State: | IL US |
Postal Code: | 626182349 |
Phone Number: | 2173231900 |
Fax Number: | 2173231914 |
NPI Enumeration Date: | 10/31/2005 |
NPI Last Update Date: | 06/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BX2000X |
License Number: | 0048835 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Oxygen Equipment & Supplies |
Taxonomy Definition: |