1255386090 NPI number — HEARTLAND REHABILITATION SERVICES OF MICHIGAN, LLC

Table of content: (NPI 1255386090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255386090 NPI number — HEARTLAND REHABILITATION SERVICES OF MICHIGAN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTLAND REHABILITATION SERVICES OF MICHIGAN, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1255386090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2015
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:
SUITE 230
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-2615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-252-5909
Provider Business Mailing Address Fax Number:
419-537-0948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6016 W MAPLE RD
Provider Second Line Business Practice Location Address:
SUITE 705
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48322-4411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-539-2900
Provider Business Practice Location Address Fax Number:
248-539-2901
Provider Enumeration Date:
05/23/2006

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-REIMBURSEMENT
Authorized Official Telephone Number:
419-252-5541

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4691580 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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