1336192434 NPI number — HEARTLAND HOME CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336192434 NPI number — HEARTLAND HOME CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTLAND HOME CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEARTLAND HOME HEALTH CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336192434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 N SUMMIT ST
Provider Second Line Business Mailing Address:
ATTN: DEAN SHIPMAN
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-254-7841
Provider Business Mailing Address Fax Number:
419-252-6448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8075 CREEKSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
PORTAGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49024-6302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-324-1811
Provider Business Practice Location Address Fax Number:
269-324-1815
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAZARUS
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VICE PRESIDENT - REIMBURSEMENTS
Authorized Official Telephone Number:
419-252-5541

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3442570 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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