Heritage Manor - Gillespie, LLC

NPI #1801130513 in Gillespie, Illinois

Provider Information

NPI Number: 1801130513
Entity Type: Organization
Organization Name: Heritage Manor - Gillespie, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: HERITAGE ENTERPRISES, INC
Primary Specialty: Durable Medical Equipment & Medical Supplies - Oxygen Equipment & Supplies
Enumeration Date: Nov 19, 2012
Last Updated: Oct 18, 2016

Practice Location

Address: 7588 STAUNTON RD
City: Gillespie
State: Illinois
ZIP Code: 62033-3232
Phone: (217) 839-2171

Authorized Official

Name: DAVID UNDERWOOD, CPA
Title: EXEC VP, CFO
Phone: (309) 823-7135

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Durable Medical Equipment & Medical Supplies - Oxygen Equipment & Supplies — Oxygen Equipment & Supplies	332BX2000X	Primary

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