Organization · Type 2 NPI

Heritage Manor - Streator

Oxygen Equipment & Supplies (DME) · Streator, IL

NPI number 1104160886 Active

Practice location

1525 E Main St
Streator, IL 61364-3162

Call (815) 672-4516 Map

Fax (815) 672-5466

Mailing address

115 W Jefferson St, Suite 401
Bloomington, IL 61701-3946

Specialties and licenses

Taxonomy	Code	License
Oxygen Equipment & Supplies (DME) Primary	332BX2000X	None listed

Oxygen Equipment & Supplies (DME): Definition to come...

15 other providers at this address

Other oxygen equipment & supplies (dme) providers in Streator

Lifetime Medical Supply Inc.Oxygen Equipment & Supplies (DME) Streator, IL NPI 1497988984

See all in Streator →

NPI record

NPI: 1104160886
Entity type: Organization (Type 2)
Issued: Nov 19, 2012
Last updated: Apr 24, 2014
Status: Active
Subpart: Yes of Heritage Enterprises, Inc

Other names

<unavail>
Heritage Health - Streator · doing business as

Authorized official

David M Underwood, CPA
SR VP & CFO
(309) 823-7135

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1104160886

Heritage Manor - Streator's National Provider Identifier is 1104160886, issued on Nov 19, 2012. The primary taxonomy on file is Oxygen Equipment & Supplies (DME) (332BX2000X), and the practice location is in Streator, IL. The record was last updated on Apr 24, 2014.