MEDICARE: HEARTLAND HOSPICE SERVICES 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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician
2	251G00000X	Community Based Hospice Care Agency	22925	NJ

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396798112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND HOSPICE SERVICES LLC

Provider Business Mailing Address
First Line	:	333 N SUMMIT ST
Second Line	:	ATTN: DEAN SHIPMAN
City	:	TOLEDO
State	:	OH
Zip	:	43604-2615
Country	:	US
Telephone Number	:	419-254-7841
Fax Number	:	419-252-6448

Provider Business Practice Location Address
First Line	:	1385 CHEWS LAND-CLEM ROAD
Second Line	:	UNIT 4
City	:	LAUREL SPRINGS
State	:	NJ
Zip	:	08021
Country	:	US
Telephone Number	:	856-251-0707
Fax Number	:	856-251-9937

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. MARTIN D ALLEN
Credential	:
Telephone Number	:	419-252-5734

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	04/28/2022

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