MEDICARE: HEARTLAND-LANSING OF BRIDGEPORT OH 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	1750N	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679515183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND-LANSING OF BRIDGEPORT OH LLC

Provider Business Mailing Address
First Line	:	333 N SUMMIT ST
Second Line	:	ATTN: BARRY LAZARUS
City	:	TOLEDO
State	:	OH
Zip	:	43604-1531
Country	:	US
Telephone Number	:	419-252-5541
Fax Number	:	419-252-5548

Provider Business Practice Location Address
First Line	:	68222 COMMERCIAL DR
Second Line	:
City	:	BRIDGEPORT
State	:	OH
Zip	:	43912-1520
Country	:	US
Telephone Number	:	740-635-4600
Fax Number	:	740-635-1723

Authorized Official
Title or Position	:	VICE PRESIDENT - REIMBURSEMENTS
Name	:	MR. BARRY A LAZARUS
Credential	:
Telephone Number	:	419-252-5541

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	02/11/2008

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