Provider Demographics
NPI:1124460720
Name:HERITAGE WOODS OF FREEPORT LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:HERITAGE WOODS OF FREEPORT LIMITED PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-935-1992
Mailing Address - Street 1:535 E NORTH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-1187
Mailing Address - Country:US
Mailing Address - Phone:815-935-1992
Mailing Address - Fax:
Practice Address - Street 1:1500 S FOREST RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-9413
Practice Address - Country:US
Practice Address - Phone:815-801-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility