Healthcare Provider Details

I. General information

NPI: 1356336028
Provider Name (Legal Business Name): HEARTLAND HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 01/23/2022
Certification Date: 01/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 MONROE ST
SYLVANIA OH
43560
US

IV. Provider business mailing address

333 N SUMMIT ST
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-2273
  • Fax: 419-885-9136
Mailing address:
  • Phone: 419-252-5500
  • Fax: 800-480-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberN/A
License Number StateOH

VIII. Authorized Official

Name: MARTIN DAVID ALLEN
Title or Position: DIRECTOR
Credential:
Phone: 419-252-5734