Healthcare Provider Details

I. General information

NPI: 1083453625
Provider Name (Legal Business Name): HEARTLAND STAFFING AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 E 52ND ST
TACOMA WA
98404-2714
US

IV. Provider business mailing address

1429 E 52ND ST
TACOMA WA
98404-2714
US

V. Phone/Fax

Practice location:
  • Phone: 253-844-7152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: PETER MUBIRU
Title or Position: DIRECTOR
Credential:
Phone: 253-844-7152