Heritage Manor - Mendota, LLC

NPI #1982948683 in Mendota, Illinois

Provider Information

NPI Number: 1982948683
Entity Type: Organization
Organization Name: Heritage Manor - Mendota, 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: Apr 24, 2014

Practice Location

Address: 1201 1ST AVE
City: Mendota
State: Illinois
ZIP Code: 61342-1815
Phone: (815) 539-6745

Authorized Official

Name: DAVID M UNDERWOOD, CPA
Title: SR. 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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