Healthcare Provider Details

I. General information

NPI: 1679515183
Provider Name (Legal Business Name): HEARTLAND-LANSING OF BRIDGEPORT OH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68222 COMMERCIAL DR
BRIDGEPORT OH
43912-1520
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 740-635-4600
  • Fax: 740-635-1723
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 Number1750N
License Number StateOH

VIII. Authorized Official

Name: MR. BARRY A LAZARUS
Title or Position: VICE PRESIDENT - REIMBURSEMENTS
Credential:
Phone: 419-252-5541