MEDICARE: HEARTLAND HOME CARE 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	251E00000X	Home Health Agency	HHA299991308	FL

General Provider Information

NPI Number	:	1891748380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND HOME CARE LLC

Provider Business Mailing Address
First Line	:	333 N SUMMIT ST
Second Line	:	ATTN: DEAN SHIPMAN
City	:	TOLEDO
State	:	OH
Zip	:	43604-1531
Country	:	US
Telephone Number	:	419-254-7841
Fax Number	:	419-252-6448

Provider Business Practice Location Address
First Line	:	1400 COLONIAL BLVD
Second Line	:	SUITE 65
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1055
Country	:	US
Telephone Number	:	239-437-0909
Fax Number	:	239-274-0166

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	01/03/2011

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