HERITAGE HEALTH - PANA
NPI 1104817816
Skilled Nursing Facility in Pana, IL

Active since November 02, 2005CLIA 14D0721179 · Waiver
1000 E 6TH ST, PANA, IL 62557(217) 562-2174(217) 562-7242 Get Directions Write a Review

NPPES record last updated: May 27, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Heritage Health - Pana NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HERITAGE HEALTH - PANA (NPI 1104817816) is a healthcare organization registered as a skilled nursing facility in Pana, Illinois and active in the NPI registry since November 2005. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists David M Underwood, Sr. Vp & Cfo, as its authorized official.

NPPES Registry Identity

NPI1104817816
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameHERITAGE MANOR PANA, LLC
Location Address1000 E 6TH STPana, IL 62557-1870
Mailing Address115 W Jefferson St, Suite 401Bloomington, IL 61701-3946 · (309) 828-4361 · Fax (309) 829-9512
Fax(217) 562-7242
Organization SubpartYesParent: Heritage Enterprises, Inc
Authorized OfficialDavid M UnderwoodSr. Vp & Cfo · (309) 828-4361
Enumeration DateNovember 2, 2005
Last NPPES UpdateMay 27, 2014
NPI 1104817816 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in IL · 0048884
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
Also ListedDurable Medical Equipment & Medical Supplies · Oxygen Equipment & SuppliesTaxonomy 332BX2000X · License 0048884 (IL)
1000 E 6TH ST, Pana, IL 62557

Other Names 1

Doing Business AsHeritage Health - Pana

Other Identifiers 3

Medicaid=========001IL
Other=========-801IL · Medicaid Oxygen Provider
Medicare OSCAR/certification145267IL

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0721179

Heritage Health - Pana · Pana, IL
Active · expires Aug 31, 2026
CLIA Number14D0721179
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorCarl Portz
Laboratory Phone(217) 562-2174
Laboratory LocationHeritage Health - Pana1000 E 6th Street Rd, Pana, IL 62557
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Occupational Therapy Assistant
1000 E 6TH ST
PANA, IL 62557
Durable Medical Equipment & Medical Supplies (Oxygen Equipment & Supplies)
1000 E 6TH ST
PANA, IL 62557
Durable Medical Equipment & Medical Supplies (Oxygen Equipment & Supplies)
1000 E 6TH ST
PANA, IL 62557
Skilled Nursing Facility
1000 E 6TH ST
PANA, IL 62557

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Heritage Manor Pana, LLC's NPI number?

The NPI number for Heritage Manor Pana, LLC is 1104817816. It was assigned to this organization in the NPPES registry on November 2, 2005. The provider is doing business as Heritage Health - Pana.

Where is Heritage Manor Pana, LLC located?

Heritage Manor Pana, LLC is located at 1000 E 6th St, Pana, IL 62557. The listed phone number is (217) 562-2174.

What is Heritage Manor Pana, LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Heritage Manor Pana, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D0721179) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Heritage Manor Pana, LLC was last updated on May 27, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.