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General NPI Number Information
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NPI Number | 1760127591
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Entity Type | Organization
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Legal Business Name | HEARTLAND HOSPICE SERVICES, LLC
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 1145 W MAIN AVE STE 205
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City | DE PERE
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State | WI
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Zip | 54115-1698
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Country | US
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Telephone | 920-336-6455
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10086
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City | TOLEDO
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State | OH
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Zip | 43699-0086
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Country | US
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Telephone | 567-585-1191
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Fax |
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Authorized Official
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Title or Position | SOLE DIRECTOR
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Name | MARTIN DAVID 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 | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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