MEDICARE: HEARTLAND BOYNTON OPCO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1043922669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND BOYNTON OPCO LLC

Provider Business Mailing Address
First Line	:	300 PROVIDER CT
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8488
Country	:	US
Telephone Number	:	917-817-3530
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 OLD BOYNTON RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-3912
Country	:	US
Telephone Number	:	561-736-9992
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED PERSON
Name	:	MATHEW VARGHESE
Credential	:
Telephone Number	:	917-817-3530

Provider Enumeration Date	:	12/14/2022
Last Update Date	:	12/14/2022

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