Provider Demographics
NPI:1346613544
Name:HEARTLAND HOME CARE, LLC
Entity Type:Organization
Organization Name:HEARTLAND HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TALMAGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-573-8118
Mailing Address - Street 1:6982 HIGHWAY 135 NORTH
Mailing Address - Street 2:
Mailing Address - City:PARAGOUD
Mailing Address - State:AR
Mailing Address - Zip Code:72450
Mailing Address - Country:US
Mailing Address - Phone:870-573-8118
Mailing Address - Fax:870-573-8117
Practice Address - Street 1:6950 HWY 135 NORTH
Practice Address - Street 2:
Practice Address - City:PARAGOULD, AR
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-573-8118
Practice Address - Fax:870-873-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR210127732253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR210127732Medicaid