Healthcare Provider Details

I. General information

NPI: 1447246632
Provider Name (Legal Business Name): HEARTLAND HOME INFUSIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MCCLINTOCK DR SUITE 106
BURR RIDGE IL
60527-0844
US

IV. Provider business mailing address

901 MCCLINTOCK DR STE 106
BURR RIDGE IL
60527-0872
US

V. Phone/Fax

Practice location:
  • Phone: 800-836-1147
  • Fax: 630-734-4678
Mailing address:
  • Phone: 800-836-1147
  • Fax: 630-734-4678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL M PETRAK
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 888-220-6432