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General NPI Number Information
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NPI Number | 1124071790
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Entity Type | Organization
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Legal Business Name | HEARTLAND HOME CARE LLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 20646 ABBY WOOD COURT SUITE 305
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City | FRANKFORT
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State | IL
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Zip | 60423-3136
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Country | US
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Telephone | 815-806-1000
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Fax | 815-806-1100
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Provider Business Mailing Address
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Address Line | 333 N SUMMIT ST ATTN: DEAN SHIPMAN
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City | TOLEDO
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State | OH
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Zip | 43604-1531
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Country | US
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Telephone | 419-254-7841
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Fax | 419-252-6448
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Authorized Official
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Title or Position | VICE PRESIDENT - REIMBURSEMENTS
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Name | MR. BARRY A LAZARUS
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Credential |
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Telephone | 419-252-5541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1008978
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License Number State | IL
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