Provider Demographics
NPI:1861499006
Name:HEARTLAND MANOR INC NURSING CENTER
Entity Type:Organization
Organization Name:HEARTLAND MANOR INC NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHRYSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-932-4081
Mailing Address - Street 1:P O BOX 10
Mailing Address - Street 2:410 N W THIRD STREET
Mailing Address - City:CASEY
Mailing Address - State:IL
Mailing Address - Zip Code:62420-0010
Mailing Address - Country:US
Mailing Address - Phone:217-932-4081
Mailing Address - Fax:217-932-4922
Practice Address - Street 1:410 N W THIRD STREET
Practice Address - Street 2:
Practice Address - City:CASEY
Practice Address - State:IL
Practice Address - Zip Code:62420
Practice Address - Country:US
Practice Address - Phone:217-932-4081
Practice Address - Fax:217-932-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0002923314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002923Medicaid
145416Medicare ID - Type Unspecified
IL0002923Medicaid
IL1301170001Medicare NSC