Organization Name: | HERITAGE MANOR CARLINVILLE, LLC |
NPI Number: | 1831180892 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID M UNDERWOOD (SR. VP & CFO) |
Mailing Address: | 1200 University Ave. Carlinville |
State: | IL US |
Postal Code: | 626269600 |
Phone Number: | 2178544433 |
Fax Number: | 2178546291 |
NPI Enumeration Date: | 10/31/2005 |
NPI Last Update Date: | 05/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BX2000X |
License Number: | 0048850 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Oxygen Equipment & Supplies |
Taxonomy Definition: |