| Organization Name: | HERITAGE MANOR MENDOTA, LLC |
| NPI Number: | 1871583906 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID M UNDERWOOD (SR. VP & CFO) |
| Mailing Address: | 1201 1st Ave Mendota |
| State: | IL US |
| Postal Code: | 613421815 |
| Phone Number: | 8155396745 |
| Fax Number: | 8155382017 |
| NPI Enumeration Date: | 10/28/2005 |
| NPI Last Update Date: | 05/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | 0048108 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |