MEDICARE: HEARTLAND HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306890926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND HOME CARE LLC

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

Provider Business Practice Location Address
First Line	:	3131 S DIXIE DR
Second Line	:	SUITE 221
City	:	DAYTON
State	:	OH
Zip	:	45439-2256
Country	:	US
Telephone Number	:	937-297-0548
Fax Number	:	937-297-0566

Authorized Official
Title or Position	:	VICE PRESIDENT - REIMBURSEMENTS
Name	:	MR. BARRY A LAZARUS
Credential	:
Telephone Number	:	419-252-5541

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/26/2008

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