Healthcare Provider Details

I. General information

NPI: 1669417879
Provider Name (Legal Business Name): HEARTLAND HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 BUSCH BLVD. SUITE 210
COLUMBUS OH
43229-1738
US

IV. Provider business mailing address

333 N SUMMIT ST ATTN: DEAN SHIPMAN
TOLEDO OH
43604-2615
US

V. Phone/Fax

Practice location:
  • Phone: 614-433-0423
  • Fax: 614-433-0640
Mailing address:
  • Phone: 419-254-7841
  • Fax: 419-252-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

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