Healthcare Provider Details

I. General information

NPI: 1851034672
Provider Name (Legal Business Name): HEARTLAND HOSPICE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WALNUT BOTTOM RD STE 302
CARLISLE PA
17015-7767
US

IV. Provider business mailing address

PO BOX 10086
TOLEDO OH
43699-0086
US

V. Phone/Fax

Practice location:
  • Phone: 717-240-0018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier100772314
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

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