Provider Demographics
NPI:1154440667
Name:HEARTLAND HEALTH CARE CENTER ADELPHI
Entity Type:Organization
Organization Name:HEARTLAND HEALTH CARE CENTER ADELPHI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOODBERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:301-434-0500
Mailing Address - Street 1:1801 METZEROTT RD
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-5101
Mailing Address - Country:US
Mailing Address - Phone:301-434-0500
Mailing Address - Fax:301-434-6311
Practice Address - Street 1:1801 METZEROTT RD
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-5101
Practice Address - Country:US
Practice Address - Phone:301-434-0500
Practice Address - Fax:301-434-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16012313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413513000Medicaid
DC037538100Medicaid
MD413513000Medicaid