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Contact Information

HERITAGE MANOR BLOOMINGTON, LLC
700 E WALNUT ST
BLOOMINGTON, IL61701-3244
 Phone: 309-827-8004
 Fax: 309-827-0256
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Geriatrics

2251G0304X 65 Physical Therapist in Private Practice
 

Occupational Therapy Assistant

224Z00000X
 

Oxygen Equipment & Supplies

332BX2000X B1 Oxygen supplier
 

Physical Rehabilitation

225XP0019X 67 Occupational Therapist in Private Practice
 

Physical Therapy Assistant

225200000X
 

Speech-Language Pathologist

235Z00000X 15 Speech Language Pathologist
Indicates primary specialty

NPI Profile & details for HERITAGE MANOR BLOOMINGTON, LLC

NPI # 1457343170
LBN Legal business name HERITAGE MANOR BLOOMINGTON, LLC
Authorized official DAVID UNDERWOOD - (SR. VP & CFO)
Entity Organization
Organization subpart 1 Yes
Enumeration date 08/18/2005
Last updated 05/27/2014 - About 12 years ago
Identifiers
IL License # 48157
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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