Organization · Type 2 NPI

Heritage Manor - Mendota, LLC

Oxygen Equipment & Supplies (DME) · Mendota, IL

NPI number 1982948683 Active

Practice location

1201 1st Ave
Mendota, IL 61342-1815

Call (815) 539-6745 Map

Fax (815) 538-2017

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...

5 other providers at this address

Allure of Mendota, LLCSkilled Nursing Facility Mendota, IL NPI 1053007443
Allure of Mendota, LLCOxygen Equipment & Supplies (DME) Mendota, IL NPI 1376237933
Heritage Manor Mendota, LLCSkilled Nursing Facility Mendota, IL NPI 1871583906
Joshua Chase Humphrey, O.T.R.Occupational Therapist Mendota, IL NPI 1326239492
Tamara Marie Morris, COTAOccupational Therapy Assistant Mendota, IL NPI 1265046213

Other oxygen equipment & supplies (dme) providers in Mendota

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NPI record

NPI: 1982948683
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 - Mendota · 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 1982948683

Heritage Manor - Mendota, LLC's National Provider Identifier is 1982948683, issued on Nov 19, 2012. The primary taxonomy on file is Oxygen Equipment & Supplies (DME) (332BX2000X), and the practice location is in Mendota, IL. The record was last updated on Apr 24, 2014.