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General NPI Number Information
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NPI Number | 1962491944
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Entity Type | Organization
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Legal Business Name | HERITAGE NURSING HOME, INC
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5888 N RIDGE AVE
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City | CHICAGO
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State | IL
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Zip | 60660-3450
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Country | US
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Telephone | 773-769-2626
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Fax | 773-769-2650
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Provider Business Mailing Address
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Address Line | 5888 N RIDGE AVE
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City | CHICAGO
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State | IL
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Zip | 60660-3450
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Country | US
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Telephone | 773-769-2626
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Fax | 773-769-2650
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. KATHY DONOHUE
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Credential |
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Telephone | 773-769-2626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0038620
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License Number State | IL
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