Provider Demographics
NPI:1073594057
Name:HEARTLAND HOME HEALTH CARE
Entity Type:Organization
Organization Name:HEARTLAND HOME HEALTH CARE
Other - Org Name:HEARTLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:KREITER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:309-671-5151
Mailing Address - Street 1:221 NE GLEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61636-0001
Mailing Address - Country:US
Mailing Address - Phone:309-671-5151
Mailing Address - Fax:309-671-2520
Practice Address - Street 1:221 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61636-0001
Practice Address - Country:US
Practice Address - Phone:309-671-5151
Practice Address - Fax:309-671-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL54008655333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL0246060002Medicare ID - Type Unspecified