HERITAGE MANOR - GIBSON CITY, LLC (NPI# 1184968885) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184968885 |
| Entity Type | Organization |
| Organization Name | HERITAGE MANOR - GIBSON CITY, LLC |
| Other Organization Name | HERITAGE HEALTH |
| Practice Address |
620 E 1st St Gibson City IL 60936-1822 |
| Mailing Address |
115 W Jefferson St Suite 401 Bloomington IL 61701-3946 |
| Practice Telephone | 2177844257 |
| Practice Fax Number | 2177848279 |
| Mailing Telephone | 3098284361 |
| Mailing Fax Number | 3098295477 |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2016-10-18 |
| Authorized Official Name | DAVID UNDERWOOD (EXEC VP, CFO) |
| Authorized Official Telephone | 3098237135 |
| Authorized Official Credential | CPA |
| Is Organization Subpart | Y |
| Parent Organization Name | HERITAGE ENTERPRISES, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332BX2000X |
Durable Medical Equipment & Medical Supplies Specialization: Oxygen Equipment & Supplies |
Suppliers |
| Other Name | Type Code |
|---|---|
| Heritage Health | Doing Business As Name - Organization |
| Street Address |
620 E 1ST ST |
| City | GIBSON CITY |
| State | IL |
| Zip Code | 60936-1822 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699765719 | Heritage Manor Gibson City, LLC | Durable Medical Equipment & Medical Supplies | 620 E 1st St, Gibson City, IL 60936-1822 | 2005-10-28 |
| 1679064612 | Sherry Lynn Darling | Occupational Therapy Assistant | 620 E 1st St, Gibson City, IL 60936-1822 | 2018-05-25 |
| 1407264385 | Elizabeth Mcburney | Speech-Language Pathologist | 620 E 1st St, Gibson City, IL 60936-1822 | 2014-07-23 |
| 1619384286 | Georganne Morris | Physical Therapist | 620 E 1st St, Gibson City, IL 60936-1822 | 2014-07-16 |
| 1255584579 | Karen E Maged | Occupational Therapist | 620 E 1st St, Gibson City, IL 60936-1822 | 2008-10-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073738738 | Carrie Ann Lithgow | Physical Therapist | 109 N. Sangamon Ave, Gibson City, IL 60936 | 2007-04-16 |
| 1144359001 | Kerrie Ann Patrick | Registered Nurse | 222 N Sangamon, Gibson City, IL 60936 | 2007-03-05 |
| 1578612800 | Donna J Boundy | Dentist | 627 E 8th St, Gibson City, IL 60936 | 2007-01-09 |
| 1093878241 | Drew Curtis Duquette | Chiropractor | 523 and One Half South Sangamon Ave, Gibson City, IL 60936 | 2006-12-19 |
| 1386727642 | Amnuay Sethakorn | Family Medicine | 4 Doctors Park, Gibson City, IL 60936 | 2006-10-23 |
| 1689687295 | Alexander V Grandt | Nurse Practitioner | 1120 N Melvin, Gibson Area Hospital & Health Services, Gibson, IL 60936 | 2006-08-14 |
| 1811125784 | Gibson Community Hospital Association | Surgery | 1 Doctors Park, Gibson City, IL 60936 | 2009-06-30 |
| 1295991701 | Trilok Shah | Psychiatry & Neurology | 4 Doctors Park, Gibson City, IL 60936 | 2008-08-04 |
| 1013050046 | Rebecca Anne Wildermuth | Specialist/Technologist | 10 Doctors Park, Gibson City, IL 60936 | 2007-02-15 |
| 1245312602 | Ginny E Pulley | Licensed Practical Nurse | 222 N Sangamon Ave, Gibson City, IL 60936 | 2006-10-19 |
| Find all providers in zip 60936 | ||||
| Taxonomy Code | 332BX2000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| Specialization | Oxygen Equipment & Supplies |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699765719 | Heritage Manor Gibson City, LLC | Durable Medical Equipment & Medical Supplies | 620 E 1st St, Gibson City, IL 60936-1822 | 2005-10-28 |
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|---|---|---|---|---|
| 1821699026 | First Choice Medical Equipment, Inc | Durable Medical Equipment & Medical Supplies | 65 S 65th St Ste 10, Belleville, IL 62223-2946 | 2020-11-04 |
| 1619596624 | Gz Service Inc | Durable Medical Equipment & Medical Supplies | 576 Jennifer Cir, Mundelein, IL 60060-4110 | 2020-04-09 |
| 1528690526 | Nationwide Medical, Inc. | Durable Medical Equipment & Medical Supplies | 415 W Golf Rd Ste 48, Arlington Heights, IL 60005-3923 | 2020-02-07 |
| 1477024347 | Karma7 Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 1840 Industrial Dr Ste 160, Libertyville, IL 60048-9400 | 2018-12-17 |
| 1700354354 | True Respiratory Care & Medical Management LLC | Durable Medical Equipment & Medical Supplies | 11415 183rd Pl Ste B, Orland Park, IL 60467-5011 | 2018-11-12 |
| 1467951699 | Sarah Bush Lincoln Health Center | Durable Medical Equipment & Medical Supplies | 903 N Maple St, Effingham, IL 62401 | 2018-02-02 |
| 1215436449 | Sarah Bush Lincoln Health Center | Durable Medical Equipment & Medical Supplies | 300 Coles Centre Pkwy, Mattoon, IL 61938 | 2018-02-02 |
| 1669992665 | Easy Oxygen Inc. | Durable Medical Equipment & Medical Supplies | 1862 E Belvidere Road #125, Grayslake, IL 60030 | 2017-06-21 |
| 1487103560 | The Elms | Durable Medical Equipment & Medical Supplies | 1212 Madelyn Ave, Macomb, IL 61455-3324 | 2016-09-29 |
| 1457807257 | Genventures Inc | Durable Medical Equipment & Medical Supplies | 101 S. College Avenue, Aledo, IL 61231-1630 | 2016-08-31 |
| Find all providers with the same taxonomy | ||||
| City | GIBSON CITY |
| Zip Code | 60936 |
Please comment or provide details below to improve the information on HERITAGE MANOR - GIBSON CITY, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.