Healthcare Provider Details

I. General information

NPI: 1013963313
Provider Name (Legal Business Name): HEARTLAND OF ADELPHI MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 METZEROTT RD
ADELPHI MD
20783-5101
US

IV. Provider business mailing address

333 N SUMMIT ST
TOLEDO OH
43604-2615
US

V. Phone/Fax

Practice location:
  • Phone: 301-434-0500
  • Fax: 301-434-1962
Mailing address:
  • Phone: 419-252-5500
  • Fax: 877-385-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number16-012
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier037538100
Identifier TypeMEDICAID
Identifier StateDC
Identifier Issuer
# 2
Identifier413513000
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: MR. MARTIN D ALLEN
Title or Position: DIRECTOR
Credential:
Phone: 419-252-5734