Healthcare Provider Details

I. General information

NPI: 1710156609
Provider Name (Legal Business Name): HERITAGE ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8570 SAINT LUKES DR
BEARDSTOWN IL
62618-9200
US

IV. Provider business mailing address

115 W JEFFERSON ST SUITE 401
BLOOMINGTON IL
61701-3946
US

V. Phone/Fax

Practice location:
  • Phone: 217-323-4055
  • Fax: 217-323-9454
Mailing address:
  • Phone: 309-823-7155
  • Fax: 309-829-9512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number1825445
License Number StateIL

VIII. Authorized Official

Name: MR. CRAIG L ATER
Title or Position: SENIOR V. P. OF FINANCE
Credential:
Phone: 309-823-7135