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General NPI Number Information
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NPI Number | 1497702054
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Entity Type | Organization
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Legal Business Name | HEARTLAND OF BROOKSVILLE FL LLC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 06/12/2017
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Provider Practice Location Address
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Address Line | 575 LAMAR AVE
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City | BROOKSVILLE
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State | FL
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Zip | 34601-3228
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Country | US
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Telephone | 352-799-2226
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Fax | 352-799-3368
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Provider Business Mailing Address
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Address Line | 333 N SUMMIT ST
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City | TOLEDO
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State | OH
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Zip | 43604-2615
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Country | US
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Telephone | 419-252-5500
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Fax | 877-385-9446
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MARTIN D ALLEN
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Credential |
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Telephone | 419-252-5734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1213096
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License Number State | FL
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