Healthcare Provider Details

I. General information

NPI: 1831130137
Provider Name (Legal Business Name): HEARTLAND OF IONIA MI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 E LINCOLN AVE
IONIA MI
48846-1314
US

IV. Provider business mailing address

333 N SUMMIT ST ATTN: BARRY LAZARUS
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 616-527-0080
  • Fax: 616-527-9443
Mailing address:
  • Phone: 419-252-5541
  • Fax: 419-252-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number344020
License Number StateMI

VIII. Authorized Official

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