Provider Demographics
NPI:1275150062
Name:HEARTLAND HOSPICE SERVICES LLC
Entity Type:Organization
Organization Name:HEARTLAND HOSPICE SERVICES LLC
Other - Org Name:PROMEDICA HOSPICE (NW INDIANA)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-252-5734
Mailing Address - Street 1:333 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-2615
Mailing Address - Country:US
Mailing Address - Phone:567-585-1191
Mailing Address - Fax:
Practice Address - Street 1:5265 COMMERCE BLVD STE A
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5327
Practice Address - Country:US
Practice Address - Phone:219-472-2020
Practice Address - Fax:219-472-2019
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND HOSPICE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-29
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based