Provider Demographics
NPI:1437379088
Name:LANDERS HEALTHCARE LLC
Entity Type:Organization
Organization Name:LANDERS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-682-4571
Mailing Address - Street 1:1825 PARADISE RD
Mailing Address - Street 2:APT 502
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-9421
Mailing Address - Country:US
Mailing Address - Phone:330-682-4571
Mailing Address - Fax:
Practice Address - Street 1:1825 PARADISE RD
Practice Address - Street 2:APT 502
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-9421
Practice Address - Country:US
Practice Address - Phone:330-642-0227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH85900034332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH270-6807Medicaid
OH5927400001Medicare NSC