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General NPI Number Information
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NPI Number | 1811181902
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Entity Type | Organization
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Legal Business Name | HERITAGE WOODS OF OTTAWA
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 801 E ETNA RD
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City | OTTAWA
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State | IL
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Zip | 61350-9106
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Country | US
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Telephone | 815-431-1400
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Fax | 815-431-9147
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Provider Business Mailing Address
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Address Line | 801 E ETNA RD
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City | OTTAWA
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State | IL
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Zip | 61350-9106
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Country | US
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Telephone | 815-431-1400
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Fax | 815-431-9147
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BARBARA JEAN WHEATLAND
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Credential | RN
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Telephone | 815-431-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | IL
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