Provider Demographics
NPI:1609903194
Name:HEARTLAND REHABILITATION SERVICES OF MICHIGAN, LLC
Entity Type:Organization
Organization Name:HEARTLAND REHABILITATION SERVICES OF MICHIGAN, LLC
Other - Org Name:HEARTLAND REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT - REIMBURSEMENTS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-252-5734
Mailing Address - Street 1:PO BOX 10086
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43699-1417
Mailing Address - Country:US
Mailing Address - Phone:419-252-5500
Mailing Address - Fax:877-385-9446
Practice Address - Street 1:7577 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9624
Practice Address - Country:US
Practice Address - Phone:734-856-6737
Practice Address - Fax:734-856-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4691580Medicaid
MI4691580Medicaid