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NPI Code Detail

MEDICARE: HERITAGE MANOR - MT. ZION, L.L.C.

MEDICARE: HERITAGE MANOR - MT. ZION, L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332BX2000XOxygen Equipment & Supplies (DME)IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497908974
Entity Type Code : Organization
Provider Name (Legal Business Name) : HERITAGE MANOR - MT. ZION, L.L.C.
Provider Business Mailing Address
First Line : 115 W JEFFERSON ST
Second Line : STE 401
City : BLOOMINGTON
State : IL
Zip : 61701-3946
Country : US
Telephone Number : 309-828-4361
Fax Number : 309-829-9512
Provider Business Practice Location Address
First Line : 1225 WOODLAND DR
Second Line :
City : MT ZION
State : IL
Zip : 62549-1237
Country : US
Telephone Number : 217-864-2356
Fax Number : 217-864-4960
Authorized Official
Title or Position : EXEC VP & CFO
Name : MR. DAVID M UNDERWOOD
Credential : CPA
Telephone Number : 309-823-7135
Provider Enumeration Date : 10/29/2008
Last Update Date : 11/29/2016

Similar Medicare Providers

1588655476 — HERITAGE MANOR - MT. ZION, LLC
Practice Location Address:
1225 WOODLAND DR
MT ZION, IL
62549-1237
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Practice Fax: 217-864-4960
1164831814 — JASON HENDERSHOT
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1225 WOODLAND DR , THERAPY DEPT
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Practice Fax:
1144639766 — SHAWN HENDERSHOT PTA
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MT ZION, IL
62549-1237
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Practice Fax:
1275942773 — COURTNEY DOTY PTA
Practice Location Address:
1225 WOODLAND DR
MT ZION, IL
62549-1237
Practice Phone: 217-864-2356
Practice Fax:
1457041303 — MOUNT ZION HEALTH AND REHAB CENTER LLC
Practice Location Address:
1225 WOODLAND DR
MT ZION, IL
62549-1237
Practice Phone: 217-864-2356
Practice Fax:
1659065985 — MOUNT ZION HEALTH AND REHAB CENTER LLC
Practice Location Address:
1225 WOODLAND DR
MT ZION, IL
62549-1237
Practice Phone: 217-864-2356
Practice Fax:

Directions to “HERITAGE MANOR - MT. ZION, L.L.C. ” Practice Location

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